• Job Description

  Req#: 15496

  Overview

  Come join a dynamic, growing team in an innovative, game-changing, healthcare organization. CareCentrix is committed to making the home the center of patient care.

  As a Medical Collector II, Reconsiderations - RCM, you will guide collectors in their performance of invoice processing activities to ensure receivables are reimbursed in an accurate and timely basis. Works directly with the payer, internal and external customers and other contract clients towards efficient and effective collection results. Works under moderate supervision.

  Responsibilities

  In this job you will:

  • Ensure the coordination of invoice activities leading to timely reimbursement of receivables using available resources including databases, internet, and telephone.
  • Research and resolve denials received that have not passed payer edits and may lead to a final appeal of denied services. Requires knowledge of a variety of system applications both internal and external. Determines and initiates action to resolve rejected invoices, prepares payer corrections, and/or appeals using electronic and paper processes.
  • Provide guidance, assistance, education, and communications with internal and external customers related to insurance and government payers claims processing protocols.
  • Utilize various resources to determine patient’s eligibility, benefits, and health plan confirmation. Including online payer databases, CareCentrix Eligibility platforms, and medical records that may result in provider or payer recoup/rejection activity.
  • Oversee accounts receivable adjustments to resolve overpayments and payment rejections according to standard operating procedures. Analyzes and clears payment variances. May prepare adjusted and corrected bills or adjust accounts receivable entries in accordance with existing operating procedures. May include the use of special reporting.
  • Evaluate, analyze and monitor the processing of invoices and on-line notes, utilizing a Windows based data processing system. Monitors payer responses, using Microsoft Excel, Microsoft Access and other software as necessary to ensure prompt payment.
  • Contact providers, physicians, and/or patients to retrieve appropriate medical documentation to substantiate services provided and engage them in assisting CareCentrix in collecting for the payer.
  • Provide payers with detailed itemization of services performed to ensure timely reimbursement. Review EOPs/EOMBs/EOBs for accuracy of patient responsibility.
  • Provide input on accounts receivable process improvements and assisting in their implementation.
  • Prepare Ad Hoc financial reports for management to use in the evaluation of accounts receivable performance.
  • Participate in teleconferences covering a wide range of topics that enables the NBC to effectively collect account receivables.
  • Assist Lead Collector with training of newly hired associates and re-education of collection teams as necessary.
  • Act as an information resource for hard to collect accounts and a “grey area” subject expert. Ensures the coordination of special handling or reconciliation of spreadsheets for national payers.
  • Monitor team results to ensure they are aligned with departmental goals.
  • Work with internal customers to identify issues which may result in new enhancements or platforms as necessary.

  Qualifications

  You should get in touch if you have:

  • High School Diploma or the equivalent plus a minimum of 3 years medical claims processing experience generally required.
  • Knowledge of healthcare collection procedures and related software applications are required.
  • Effective analytical and communication skills also required as well as knowledge of HIPPA, The Fair Credit and Collections Act, HCPC, CPT, ICD-9 coding, intermediate competency of Microsoft Office Applications, and mathematical calculations.
  • Knowledge of Utilization Management and URAC standards.

  What we offer:

  • Competitive Salary Range: $17 - $22 / hour plus corporate bonus incentives
  • Full range of benefits including Health, Dental and Vision with HSA Employer Contributions and Dependent Care FSA Employer Match.
  • Generous PTO, 401K Savings Plan, Paid Parental Leave, free on-demand Virtual Fitness Training and more.
  • Advancement opportunities, professional skills training, and tuition Reimbursement
  • Great culture with a sense of community.

  CareCentrix maintains a drug-free workplace

  #IDCC

  We are an equal opportunity employer. Employment selection and related decisions are made without regard to age, race, color, national origin, religion, sex, disability, sexual orientation, gender identification, or being a qualified disabled veteran or qualified veteran of the Vietnam era or any other category protected by Federal or State law.

• About the company

  We are architecting the future of care at home through a holistic view of post-acute care, determining the best clinical path, and guiding care to the home.

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