Job Ref # 39501

M - F

Job Summary

Performs ongoing monitoring of assigned accounts to ensure maximization of collection dollars by providing appropriate follow-up and documenting actions taken. The Commercial Collector often times has direct contact with other Methodist Health Care System departments as well as insurance companies; therefore, this position requires a candidate whom demonstrates a positive demeanor, good verbal and written communication skills, and is professional in both appearance and approach. The employee must demonstrate strong interpersonal and persuasive abilities in order to secure accurate and timely payment from third party payors. The incumbent is responsible for ensuring that the network`s financial viability is secured at the most basic level by securing accurate and timely payments. Any errors may result in a delay or loss of reimbursement. Extensive and in depth interaction with insurance, governments entities, and clinical personnel (i.e. physicians, nurses, tech, etc.) is required. Additionally, the Commercial Collector must remain cognizant that the relationship with the third party payor must be maintained. Candidate must be able to handle potentially stressful situations and handle multiple tasks at one time. He/she must be a positive role model for other staff members and patients by working with them to promote teamwork and cooperation. Candidate must be able to accept behavioral and technical feedback as well as integrate suggestions in effective ways. As a member of the Methodist Health Care System team, this person must comply with Methodist Health Care System and Patient Accounting policies and procedures.     

DUTIES AND RESPONSIBILITIES   

The Commercial Collector works independently to secure payment from third party payors. He/she must exercise financial acumen in negotiating prompt pay discounts and resolving disputes related to covered services. These tasks include, but not limited to the following:

1. Contact and monitor each account assigned. All accounts in the work queue must be worked at least once within a 2-week period. All new patient accounts must be reviewed within 21 days from the date the claim was filed. All clean claims filed must be verified that they have been received within the payor`s filing deadline. Must work at lease the minimum accounts per day as specified (45 for high dollar rep, 60 for BCBS rep, 50 for all others).
2. Provide clear and concise documentation of every action taken on an account in the system collection notes.
3. Displays assertiveness in resolving accounts and takes the appropriate action. Actions may include, but are not limited to: Obtaining corrected information and requesting rebills. Responds to payor`s request for additional information/documentation within 3 days of receipt. Confers with Billers, as necessary, to obtain additional information/clarification. Co-ordinate requests for medical records. Posting account adjustments as a result of written communication from third parties (i.e. certain contractual adjustments, EOB`s, etc.). Provides balance breakdown to document the status, (i.e., primary payor balance, secondary or credit balance, patient balance).
4. Ensure maximization of collection dollars from insurance companies in accordance with the respective contract and/or Methodist Health Care System financial arrangement.
5. Identify accounts for advanced due diligence steps or legal placement in accordance with CCMC`s Account Documentation policy and procedure.
6. Remain current on collection procedures of various payors to provide assistance for absence (vacation, etc.).
7. Inform Manager of payer trends, or any problems or changes in payor requirements.
8. Follows through, in a timely manner, on all action steps requested by the manager or director.
9. Meets stated Performance Indicator Expectations for productivity, account reviews, and agings, as demonstrated on weekly Key Performance Indicator Document.
10. Handles all internal and external customers using ICARE and Service Plus principles. *Contacts are defined as substantively working an individual account in accordance with CCMC`s defined work expectations detailed in the Account Documentation policy and procedure.  Understands payor environment, such as managed care, IPAs, TPAs. Exercises good judgment in handling of accounts and demonstrates a professional approach in dealing with patients and insurance companies.     

EDUCATION REQUIREMENTS   

• High School Diploma with some additional education (i.e. computer training, communication classes, etc.), college degree preferred.

EXPERIENCE REQUIREMENTS   

• 2  years experience in commercial insurance follow-up.     

SPECIAL KNOWLEDGE, SKILLS AND ABILITIES REQUIRED   

1. Understands payor environment, such as managed care, IPAs, TPAs.
2. Exercises good judgment in handling of accounts and demonstrates a professional approach in dealing with patients and insurance companies.     
3. Understanding of insurance contractual agreements and appeals process.
4. Sharp analytical abilities are required in order to resolve the hospital`s patient accounts in a timely and correct manner.
5. Good verbal and written communication skills in the English language.      
6. Knowledge of billing and government programs preferred.
7. Basic typing, PC and word processing skills required. 
8. Ability to follow-through and handle multiple tasks simultaneously.
9. Ability to work independently.
10. Bilingual a plus.

Equal Employment Opportunity
Houston Methodist is an Equal Opportunity Employer.