Whittier Medical Management Inc
  • 21-Mar-2019 to 20-May-2019 (PST)
  • Accounts Receivable A/R
  • Torrance, CA, USA
  • Full Time

Medical, Dental, PTO, 401k


Experience working with Facility/ASC Claims and/or Orthopedic Specialties HIGHLY desired.

Job Title: FACILITY Orthopedic Experienced Medical Insurance Collector

Reports To: Senior Account Manager

Direct Report : None

Dept: Operations

FLSA Status: Non-Exempt

Site: Torrance

Employment Status: Full-Time

Position Overview

Successfully handle a variety of insurance account receivable (AR) collection needs including, but not limited to: correcting and resubmitting claims via paper and electronic submission methods, correcting clearinghouse rejections, inter-departmental claims information sharing, writing appeal letters with supporting documentation, researching refund requests and routing to the appropriate department for resolution.  Identifying denial/rejection trends and communicating your findings with the necessary departments/staff.  Running monthly aging reports and working them accordingly.  Complete 40 accounts per day, measured on an average monthly basis.  Attain an error rate of 3% or less on claims resolution.  All activities demand timely and professional, courteous interactions.  This job description is intended to convey information essential to understanding the scope of the  Facility Orthopedic Experienced Medical Insurance Collector position and it is not intended to be an exhaustive list of skills, efforts, duties, responsibilities or working conditions associated with the position.

Essential Functions

  1. Review zero pay explanation of benefits/electronic remittance advice notices daily.  Research validity of denial and take appropriate action to correct the claim.  Identify denial trends and report findings to lead, management, or other departments as relevant.
  2. Speak with patients or their representatives to identify problems relating to their care/billing.
  3. Refer patients to appropriate insurance companies or resources with guidance on what action must be taken to resolve their claim denial.
  4. Investigate and resolve claim rejections from clearinghouse, as needed. 
  5. Call insurance companies to investigate and resolve claim denials/rejections.
  6. Write appeal & provider dispute letters to various insurance companies including Medi-Cal, Medicare, private payers, work comp, HMO, PPO, POS, self-insured, third party administrators.
  7. Run various aging reports in multiple practice management platforms.  Export reporting into Microsoft Excel for analyzation.  Utilize pivot tables, data validation, sorting features, etc. to aid in analytics.
  8. Collect and report data on topics such as insurance/patient encounters and inter-office operational issues, making recommendations for change when appropriate.
  9. Read current literature, talk with colleagues, continue education, or participate in professional organizations or training/conferences to keep abreast of developments in the field.
  10. Identify and share research, recommendations, or other information regarding legal liabilities, risk management, or quality of care.
  11. Must achieve established productivity & quality measures.
  12. Must respond to customer/patient/insurance company inquires in a timely and professional manner.
  13. Must perform a variety of duties, often changing from one task to another.

*Other duties as needed or required.

Qualifications/Knowledge and Skills

  1. High School graduate
  2. Minimum two years experience in office based, ambulatory surgical center or anesthesia billing and/or collections
  3. Experience with accounts receivable, credit and collections, primary and secondary billing, financial coding, coding and posting of payments, credit refunds, insurance verification, provider contracting and collection of past due accounts a plus.
  4. Windows software knowledge necessary.
  5. Strong typing skills necessary for completion of collection duties.

Physical Demands and Work Environment

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the functions. While performing the duties of this position, the employee is regularly required to talk or hear. The employee typically sits for extended periods at a computer workstation. The employee frequently is required to use hands or fingers, handle or feel objects, tools, or controls. The employee is occasionally required to stand; walk; sit; and reach with hands and arms. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this position include close vision, distance vision, and the ability to adjust focus. The noise level in the work environment is usually low to moderate.

Note

This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an "at will" relationship.

The company is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

Whittier Medical Management Inc
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