Collector, Management Services Organization​/Centralized Billing Office - CBO

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 guidelines. Responsible for ensuring timely filing and guidelines are met; provided quality control checks on paper and electronic claims; process tracers, denial and related correspondence; initiate appeals; 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 approach. 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. TYPE OF SUPERVISION RECEIVED:
Direct supervision required. Daily, weekly and/or monthly Unit meetings may be required. Direct review of daily production and other production-based reports to validate staff usage needs, portfolio reduction efforts, customer services and staff morale.

• TECHNICAL DUTIES
• Billing Tasks 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, MSP billing. 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 electronically.
  
  Understands all billing vendors used by the MSO - CBO. Contacts 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 the sponsor. 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 ABN's, and CMS certs and recerts.
  
  Obtains and reviews the medical record or on‑line reports for additional documentation to be attached to hardcopy claim forms. 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 daily 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…