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Medical Collector

Company: Agendia, Inc.
Location: Irvine
Posted on: November 10, 2019

Job Description:

  • The Medical Collector follows-up on the status of submitted claims and invoices; requests medical records as needed; prepares various medical appeals and the submissions of such appeals to insurance carriers; follows-up on all submitted medical appeals in a timely manner. Essential Duties and Responsibilities:
    • Collects money due from insurance companies, hospital and patients in compliance with CLIA, OIG and all other applicable legal requirements.
      • Contacts insurance companies to follow up on claims and appeals which have been submitted, but no payment or correspondence received within the allotted time frame.
      • Processes and follows up with patients for copays and deductible amounts due.
      • Contacts clients to obtain medical records as needed for submission of a medical appeal or payer's review of a claim.
      • Prepares custom appeal letters and letters of interest to various insurance carriers and managed care groups.
        • Reviews files to determine if amounts should be written off based on acceptable reimbursement, then forwards these to the Reimbursement Director.
        • Investigates and prepares any necessary refund requests from payors for submission to the Reimbursement Director.
        • Negotiates reimbursement single settlements with various insurance carriers and third party administrators, based upon department guidelines.
          • Interfaces with insurance company representatives, doctor's offices and hospitals regarding schedule of services and billing inquiries.
            • Assists department director in the development of new procedures and systems to enhance productivity.
            • Provides account information to the sales force as needed. The above listing represents the general duties considered essential functions of the job and is not to be considered a detailed description of all the work requirements that may be inherent in the position. Education and Experience Requirements:
              • High school diploma or general education degree
              • 3+ years related experience
                Skills and Qualifications Requirements:
                To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to individuals with disabilities to perform the essential functions.
                • Advanced technical knowledge of Microsoft products required (Excel, Word, Outlook)
                • Must be able to work in a fast-paced environment
                • Must have strong organizational skills and attention to detail
                • High degree of accuracy
                • Manage multiple tasks independently
                • Other skills necessary are accounting, data entry, general math, analytical, thoroughness, research, verbal/written communication
                • Excellent problem resolution
                • Excellent customer service skills
                • Outside-the-box thinker Supervisory Responsibilities:
                  • This position requires no supervisory responsibilities.
                    Travel:
                    • This position requires no travel to perform duties
                      Environment/Safety/Work Environment:
                      • General office environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
                      • Maintains a clean, neat, and orderly work area.
                      • Adheres to Department Specific Safety Guidelines.
                      • Establishes ADA (Americans with Disabilities Act) requirements Physical Demands:
                        • Standing, sitting, walking, bending, reaching, manual manipulation, and light lifting up to 15 pounds.

Keywords: Agendia, Inc., Irvine , Medical Collector, Healthcare , Irvine, California

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