Avispa Technology Senior Collection Representative 436995 in Emeryville, California

Sr. Collection Representative


• The Government, Commercial, Contract and Managed Care (CCMC) Units are responsible for the accounts receivable, billing, and follow-up of all government or commercial, contract and managed care payers. • The units deal regularly with complex policy and procedural issues that involve contract compliance with regard to Medicare, Medi-Cal, CCS, HMO and PPO payers. • It is the units’ responsibilities to communicate and to coordinate throughout various company Medical Center departments, including the company's billing agents to ensure the quality of the university’s billing process. • Within these units, the Follow-Up Representatives are responsible for billing and follow-up of government, commercial, contract and/or managed care accounts receivables for MGBS clients. • The incumbent demonstrates the ability to perform all aspect of billing and follow-up with quality • The incumbent’s main task is to resolve all outstanding insurance accounts through constant communication with the payers (by phone or via web access), other MGBS units, company's clinical departments and billing agents. • When resolving the accounts receivables; the Follow-Up Representative must adhere to the MGBS SRG (Situation Response Guide) to ensure consistency with the follow-up and documentation processes and to maintain good quality work. • The Follow-up Representative must meet minimum productivity standards and quality expectations of their units. • The Follow-up Representative must attend and be engaged in unit and team meetings aimed at increasing knowledge. • The incumbent will utilize web based tools, including payer websites and the RMS website prior to calling payers. • The incumbent will conform to all company, MGBS, government and HIPAA policies and procedures.


• Examines and evaluates accounts for appropriate follow-up action consistent with guidelines and documentation protocols prescribed in the SRG (Situation Response Guide). • Make daily inquiries on unresolved invoices by phone or via the internet • Interpret account information and enter important details to provide an audit trail for further follow up • Research missing payments by reviewing EOB (Explanation of Benefits), APEX and RMS • Review of non-payment and/or incorrect payment for possible appeal. This may include, but is not limited to the use of the following reference tools and guidelines: ◦ CCI edits ◦ Company Contract Report ◦ Profee Grid ◦ Medicare Fee Schedule ◦ Cascading guidelines ◦ CPT, ICD-9 or ICD-10, HCPC, Medical Terminology Manuals.

• Analyze Explanation of Benefits (EOBs) for accurate posting of rejection, adjustment and other posting requirements needed in APEX • Adheres to the rules and regulations of the different types of payers such as Medicare, Medi-Cal, CCS, PPO, EPO, HMO, and commercial insurance • Initiate Charge Correction request • Submit requests to department via RFI (Request for Information) process and review response for appropriate action • Retrieve all required information needed in order to evaluate correct credit balance and/or correct refund payee • Complete and submit refund request with detailed back-up to the unit manager for approval • Effectively communicate with MGBS peers, payers, patients, company departments Leads, Assistant Managers and managers • Utilize knowledge of various systems including, but not limited to: ◦ Microsoft Word, EXCEL, Outlook, APEX, Payer Web Portals, Health Logic, government and/or non-government websites, and any other information systems which would be required for insurance eligibility, benefit verification or other information needed during detailed follow-up

• Other Follow Up Duties May Include: • Secure guarantor/patient demographic and /or insurance information as required • Process correspondence as required in accordance with departmental procedures • Billing or rebilling corrected claims • Create Orthopedic DME (Durable Medical Equipment) Invoice form for DME billing attachment • Notify manager of possible procedural change for improving efficiency • Perform other duties as assigned

Perform Special Projects or Other Duties as Assigned by the Assistant Manager or Manager

Attend and be engaged in monthly CQI and KPI (monthly one on one) meeting and unit and team meetings aimed at increasing knowledge

Service Excellence:

• Demonstrates service excellence by following the Everyday PRIDE Guide with the company's standards and expectations for communication and behavior. These standards and expectations convey specific behavior associated with the Medical Center’s values: Professionalism, Respect, Integrity, Diversity and Excellence, and provide guidance on how we communicate with patients, visitors, faculty, staff, and students, virtually everyone, every day and with every encounter. • These standards include, but are not limited to: Personal appearance, acknowledging and greeting all patients and families, introductions using AIDET, managing up, service recovery, managing delays and expectations, phone standards, electronic communication, team work, cultural sensitivity and competency • Uses effective communication skills with patients and staff; demonstrates proper telephone techniques and etiquette; acts as an escort to any patient or family member needing directions; shows sensitivity to differences of culture; demonstrates a positive and supportive manner in which patients/families/colleagues perceive interactions as positive and supportive. Exhibits team work skills to positively acknowledge and recognize other colleagues, and uses personal experiences to model and teach Living PRIDE standards. • Exhibits tact and professionalism in difficult situations according to PRIDE Values and Practices • Demonstrates an understanding of and adheres to privacy, confidentiality, and security policies and procedures related to Protected Health Information (PHI) or other sensitive and personal information • Demonstrates an understanding of and adheres to safety and infection control policies and procedures • Assumes accountability for improving quality metrics associated with department/unit and meeting organizational/departmental targets


• At least 1 year of previous Insurance Follow up experience • Demonstrate the Ability to communicate effectively (orally and written) • Knowledge of CPT/ICD-9 or ICD-10 • Experience With Denials Management • Experience with MS EXCEL and OUTLOOK • Effective Time Management and Ability to Meet Deadlines • Ability to work independently or as needed with a team • Ability to meet productivity and quality standards • Demonstrates positive attitude and excellent customer service skills • Proven ability to coach and mentor staff for optimal results • Ability to set priorities, goals and objectives • Demonstrate the ability to perform all aspects of billing and follow-up with superior quality • Excellent Attendance Record


• Prior working knowledge of the EPIC (Apex) system, especially PB or HB Insurance Follow up Module(s) • Certified Procedural Coder (CPC) • High School Graduate or GED equivalency • Associates or Bachelor’s Degree


• Identify all licenses or certifications required by law or Medical Center policies to perform the duties, i.e., a California Registered Nurse License (RN), California Nurse Practitioner License (NP), or a California driver’s license (CDL).

$24 Per Hour Emeryville CA 94608 3 Month Assignment