Job Title

The Medical Collector I is a full-time position responsible for managing denials and collecting outstanding account receivables securing payment of denied claims for Medical, Dental, Optometry, Behavioral Health, OB-GYN, and Podiatry, claims. This is a challenging and rewarding position that requires strong communication skills, attention to detail, and the ability to work in a fast-paced environment. This position reports to the Billing Manager, in some cases, the focus may be on either coding or billing but must be cross trained in both. Benefits: * Free Medical, Dental & Vision * 13 Paid Holidays + PTO * 403 (B) retirement match * Life Insurance, EAP * Tuition Reimbursement * Flexible Spending Account * Continued workforce development & training * Succession plans & growth within Qualifications/Licensure: Education, Experience, & Knowledge * Three (3) years of experience with revenue cycle operations management with excellent presentation and writing skills. * Advanced skills in analysis and MS Office suite. * eClinical Works experience is preferred. * High School diploma or GED required. * Billing Certification required. * Demonstrated knowledge of all Insurance companies, HMO's, PPO's Government and State programs Medi-Cal and Medicare, and third-party payers. * Experience with managing revenue cycle processes including Medicaid and Medi-Cal eligibility, health information management and billing, and charge capture processes. Responsibilities: Performs a combination, but not necessarily all, of the following duties: * The billing department encompasses medical coding, charge entry, claims submissions, payment posting, accounts receivable follow-up, and reimbursement management. * Works through patient insurance documentation, billing and collections, and data processing to ensure accurate billing and efficient account collection. * Analyzes billing and claims for accuracy and completeness; submit claims to proper insurance entities and follow up on any issues. * Follows up on claims using various systems, such as eClinical Works, Claim Remedi clearinghouse, Medicare DDE, Online payer sites, etc. * Maintains contacts with other departments to obtain and analyze patient information to document and process billings. * Analyzes trends impacting charges, coding, collection, and accounts receivable. * Successfully scrubs and quality controls claims prior to submission. * Works the A/R, works rejected claims, and provides necessary follow-up to ensure successful claim processing. * Generate month end close patient financial communication letters and statements * Provide quality control checks of denied claims, the ability to process tracers, process contractual adjustments and allocation of funds; initiate appeals * Evaluate remittance to ensure accuracy and analysis of CAS and denial codes. * Maintains strong attention to detail and ability to multi-task. * Maintains extremely high standards of professional conduct. * Establishes and maintains effective working relationships with the office staff and Doctors. * Adheres to policies regarding safety, confidentiality, and HIPAA guidelines. * Ensures that the activities of the collection operations are conducted in a manner that is consistent with overall department protocol and are in compliance with Federal, State, and payer regulations, guidelines, and requirements. * Serves as a practice expert and go-to person for denials questions and advice. * Performs other job duties as assigned. St. John's Community Health is an Equal Employment Opportunity Employer