Company: CYNET SYSTEMS
Posted on: March 11, 2023
Pay Range: $24 - $27
- The Collector Appeal Specialist is responsible for accurately
processing inpatient and out-patient claims to third party payers
and private pays, following all mandated billing
- Responsible for ensuring timely filing and guidelines are
- Provided quality control checks on paper and electronic claims;
process tracers, denial and related correspondence; initiate
- Compose and submit appeal letters specific challengeable denial
issues consistent with the most update American Medical Association
Current Procedural Terminology.
- Must demonstrate a positive demeanor, good verbal and written
skills, and must be professional in both appearance and
- Will maintain consistent productivity standards as appropriate
for their unit as well as maintain an average of 90% (score 9.0) or
better on Quality Reviews.
- The Professional Billing Refund Collector is responsible for
accurately reviewing credit balances and processing adjustments,
transfers and refunds as needed.
- Helps in billing operations by providing support and research
of misapplied payments.
- Works as a member of the billing team to provide smooth
operational flow resulting in optimum customer (internal/external)
satisfaction and effective/efficient processes.
- Must have previous experience with billing and collecting for
all insurance types.
- Must be able to evaluate denied claims and respond
appropriately to denial by providing additional information,
writing an appeal.
Type of Supervision Received:
- Direct supervision required.
- Daily, weekly and monthly Unit meetings may be
- Direct review of daily production and other production-based
reports to validate staff usage needs, portfolio reduction efforts,
customer services and staff morale.
- 2 Years of experience preferred.
- Combined education/experience as a substitute for minimum
- Experience with medical services collections for any
combination of payors (Medicare, Medi-Cal/Caid, HMO, PPO,
Commercial, and Private Pay).
- Excellent communication skills both written and oral, detail
knowledge of applicable collection laws/policies/principles/etc.,
governing collection efforts, problem identification and
resolution, insurance, medical terminology, and reimbursement
- Expert skill-level in specialty area.
- Experience in computing environments.
- User support experience with servers, operating systems,
workstations, networks, LANs and network software.
- Analyzes and determines which billing procedure should be
followed, based upon the type of financial class, e.g., contracts,
private insurance carrier, HMOs, government programs,
Federal/State/Local, Self-Pay accounts in conjunction with type of
billing: transplants, grants, trauma and indigent programs, LOAs,
- Analyzes the information submitted by the various departments
for billing and the appropriate documentation required for
processing a claim form whether submitted hard copy or
- Understands all billing vendors used by the MSO - CBO.
- Contact by telephone or e-mail the appropriate departments to
obtain the required information needed to process a claim.
- Analyzes the pre-printed information on the claim form(s) or
billing system to ensure that it is accurate and consistent with
other information contained in Cerner or patient accounting system
and makes corrections as necessary.
- Edits charges on the claim form(s) or billing system for which
departmental and payer guidelines stipulate should not be billed to
- Recomputes the total amount due prior to submitting the claim
e.g. edits unbillable charges for all payors.
- Reviews the claim forms to identify sensitive diagnosis
information and follows guidelines and procedures established by
the department to maintain patient confidentiality.
- Review Charges/Encounter Forms for accurate billing information
and assure that data fields are correct.
- Inputs all the required information needed to complete the
claim, edit accordingly and submit either hardcopy or
electronically, with all the required documentation. i.e.
authorizations, reimbursement based on LOAs, medical records,
sterilization consent forms, treatment authorization requests,
authorizations, hysterectomy consent forms, Inpatient/Outpatient
TARs and SARs, and ABNs, and CMS certs and recerts.
- Obtains and reviews the medical record or on-line reports for
additional documentation to be attached to hardcopy claim
- Transmits claims via electronic vendor, once all corrections
and adjustments have been processed.
- Submits completed claim forms to appropriate carriers with all
required supplemental documentation.
- Submits hard copy claims via certified mail.
- Works and resolves reject for all assigned claims
- Bills for late charges as needed.
- Communicates identified billing issues and trends to Supervisor
and Billing Manager in a timely manner.
- Communicates issues with claim scrubber edits to Supervisor and
Billing Manager in a timely manner.
- Communicates issues that impact bill holds with outside
vendors: i.e. CMRE/RSI Collection Agencies to reporting
- Utilize CPT, ICD-10-CM, HCPCS, Insurance Directories and other
insurance books as well as Cerner, AIDX/Client and other systems to
solve billing issues and problems.
- Utilize all systems as applicable. etc.
- Complete tasks based on the assigned priority matrix.
Follow Up Collections:
- Follow-up and collect on accounts for all payers, including
Medicare, Medi-Cal, commercial, guarantor, and other contracted
- Primary follow-up assignment is to facilitate payment for
accounts previously billed.
- Review each patients case, correspondence, and current computer
data to determine possible payment problems.
- Maintain a portfolio of such accounts with optimum cash
collections, adjustments and closures.
- Perform follow-up on all outstanding insurance claims.
- Document all activity.
- Manage and process assigned computerized (i.e., ETM, etc.) or
manual worklist in a timely manner to ensure that MSO CBO achieves
its overall collection standards and quality measures.
- Call appropriate third-party contacts and establish specific
reimbursement status, i.e. reason for any discrepancy between
expected and actual reimbursement amount and date of
- Be aware of courtesy rates and/or courtesy
- Adjustments / Write-Offs / Updates.
- Submits necessary adjustments using the correct debit or credit
transaction in order to correct account balance and/or claim totals
prior to submission.
- Submits adjustments with appropriate codes.
- When circumstances warrant, transfers all or parts of a patient
account charges to the correct account.
- Submits charge corrections and/or combines charges correctly
via patient accounting system.
- Updates case / payer data and documents the reason for the
updates; requests rebills as necessary.
- Submits adjustment requests to immediate Supervisor for review
- Applies proficiency in understanding and applying contractual
terms of our Managed Care contracts (i.e., PPO, HMO, EPO, POS,
Medi-Cal, Medicare, etc.).
- Applies knowledge of Cerner, AIDX/Client and other
- Demonstrates knowledge in various payor websites.
- System Folder Notes / Account Documentation.
- Documents claim bill date, billed amounts, billing address,
billing attachments, invoice number, expected payment, contractual
amount, received payments, actual transplant date(s), type of
transplant, pre and post periods for transplant days, and all
pertinent billing data relevant to billing the claim.
- Documents in a clear, concise and grammatically correct manner
in system folder notes.
- Uses appropriate collector comment codes.
- Assists in special projects or other duties as
- Meetings, general support to other areas and office
- Attends training classes.
- Assists in training co-workers if needed.
Keywords: CYNET SYSTEMS, Alhambra , Collector, Other , Alhambra, California
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