- Addresses all incoming inquiries from any customer; patient, insurance company, Hoag employee, whether by telephone, mail or in person.
- Documents all activity in the facility’s legacy, Patient Accounting System.
- Is familiar with Medicare secondary payer (MSP), Medi-Cal and other government programs, in order to refer patients for financial assistance.
- Is familiar with the facility’s charity and payment plan options, in order to assist the patient without third-party coverage.
- Contacts patients regarding self-pay balances on the accounts receivable to evaluate patient’s ability to pay and collect monies due to the hospital
Collector, Self-Pay Specialist Level I includes but is not limited to the following:
- Assists patients with billing inquiries and insurance questions communicate findings in a professional manner.
- Contacts patients/guarantors to secure payment for services provided.
- Documents all calls and actions taken in the appropriate systems. Sets next work date if follow-up is needed.
- Confirms/updates with patient/guarantor insurance and patient demographic information.
- Makes appropriate changes and submits/re-submits claims as indicated.
- Informs patients/guarantors of opportunities for financial assistance, including Medi-Cal/MSN and other available governmental or private programs.
- Accurately code insurance plan codes, update current payer being billed and request an 837 as appropriate.
- Is familiar with the financial assistance program to provide patient/guarantor assistance with completion when appropriate.
- Establishes a payment arrangement when patients are unable to pay in full, at time of payment is due This may include installment plans and patient settlements, in accordance with Hoag policies.
- Patient complaints/disputes are documented and forwarded to the supervisor.
- Responsible for following all collection policies and procedures.
- Meets quality assurance and productivity standards.
- Returns all voice mail messages/emails on the same day received.
- Generates itemized bills as needed to any customer, internal or external.
- Assists with distribution, review, and work of incoming faxes, amended orders and other inquiries received via fax or other assignments during zero calls in queue.
- Takes part in all training about third-party requirements.
- Participates actively in any training opportunities to enhance knowledge to help Hoag patients.
- Accurately sets up payment plans, updates to the accounts or other necessary updates inaccurately in all applicable systems.
- Ability to review and identify applicable cash rates, special rates, applicable professional and employee discounts based on policies and procedures.
- Demonstrates knowledge and is able to process bankruptcy and deceased patient accounts.
- Performs other duties as assigned
Education, Training and Experience
- High School graduate or equivalent.
- Understanding of hospital reimbursement methodologies, including DRGs, APCs, and standard payment methodology.
- Strong customer relation skills.
- Ability to communicate well both verbally and in written form.
- Ability to interact with all levels (patients, hospital staff, physicians, vendors)
Skills or Other Qualifications
- Expert knowledge of self-pay collection techniques.
- Working knowledge of Medicare, Medicaid, and all other third-party payment methods.
- Effective written and verbal communication skills.
- Excellent customer service skills and telephone etiquette.
- Problem-solving skills essential.
- Insurance knowledge and communication with payers.
- Ability to think independently and use good judgment for situations which require initiative and innovation.
- Computer literacy, including proficiency in Word and Excel, some knowledge of Access (preferred).
- Knowledge of basic office equipment.
- Ability to establish work priorities and prioritize needs to meet required timelines.
- Analytical and problem-solving skills.
- 10 Key by touch and ability to type 40 WPM.
- Basic math calculation skills
- Bilingual English and Spanish