Providence Associate Collections Representative (FTE 1.0, Days) in Lubbock, Texas
Providence St. Joseph Health is calling an Associate Collection Representative (Full-Time, Days) to our location in Lubbock, TX.
We are seeking an Associate Collection Representative who will be responsible for performing insurance liability collection and accounts receivable activities for commercial accounts (PPO, HMO, POS, Managed Medicare/Medicaid, Private etc.) to ensure the timely receipt of insurance liabilities for hospital services. This individual follows up on accounts regularly to verify timely receipt of claim, check claim status, submit required documentation, and track overall claim processing. In addition, this individual identifies functional issues and barriers and reports them to the PFS Manager.
Associate Collections Representative (Southern California): This individual reports to the Southern California Co-Op PFS Commercial Collections Manager and is responsible for collections activities related to all commercial / private insurance accounts for the Southern California region.
Associate Collections Representative (Southwest): This individual reports to the Regional PFS Manager and is responsible for collections activities related to all commercial / private insurance accounts for the Southwest region.
In this position you will:
Complete and independently manage account follow-up based on preset follow-up guidelines defined by payor type and account balance:
Verify claim is received by commercial payor timely in accordance with the timely filing limits of the contractual agreement and/or state or federal regulations.
Monitor accounts receivable daily through work-lists and check claim status through payor claims department or online to ensure proper claims processing.
Complete periodic payor phone calls to confirm claim status and drive claim resolution as dictated by department collections policies.
Document follow-up activity or pertinent notes (e.g., date of receipt, reference number) within the system of record to track and record overall claim process history.
Obtain and submit any necessary documentation to support claim processing if required by the contractual agreement, payor guidelines, or state or federal law.
Report any critical account issues or barriers in the collections process to the Co-Op PFS Manager.
Trend and document ongoing payor issues and notify PFS management.
Ensure that all activities related to hospital collection functions meet department requirements, maximize revenue collection, and achieve leading practice levels of performance.
Daily focus on attaining productivity standards, recommending new approaches for enhancing performance, and productivity when appropriate.
Required qualifications for this position include:
Experience in medical management computer applications
Knowledge of medical terminology, UB-04 claim form, and familiarity with CPT-4 and ICD-9 coding
Knowledge of computer software programs and use of basic office equipment
Analytical and problem-solving skills
Preferred qualifications for this position include:
H.S. Diploma or GED
1 year health care business office experience or related field
3 years collections experience and medical terminology
Quantitative skills:Ability to calculate expected reimbursement based on contract rates or fee schedules
Familiarity with the 835 transaction code set
About the department you will serve.
Providence Strategic and Management Services provides a variety of functional and system support services for all eight regions of Providence Health & Services from Alaska to California. We are focused on supporting our Mission by delivering a robust foundation of services and sharing of specialized expertise.
For information on our comprehensive range of benefits, visit:
As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.
Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
Job Category: Billing/Insurance
Req ID: 279748