Credit Resolution Specialist/Commercial Collector
- Duarte, CA
About City of Hope
City of Hope, an innovative biomedical research, treatment and educational institution with over 6000 employees, is dedicated to the prevention and cure of cancer and other life-threatening diseases and guided by a compassionate, patient-centered philosophy.
Founded in 1913 and headquartered in Duarte, California, City of Hope is a remarkable non-profit institution, where compassion and advanced care go hand-in-hand with excellence in clinical and scientific research. City of Hope is a National Cancer Institute designated Comprehensive Cancer Center and a founding member of the National Comprehensive Cancer Network, an alliance of the nation’s leading cancer centers that develops and institutes standards of care for cancer treatment.
To efficiently and collectively collect reimbursement for professional services rendered. The Collector is in charge of monitoring and processing accounts that are both straightforward or may need further research in order to bring resolution. The Collector will work with minimal supervision from management to ensure the integrity of the work performed. The Collector works in a team environment to fulfill the mission and goals of the Division.
Key Responsibilities include:
- Follow-up all assigned accounts from within billing and accounts receivable system in accordance with pre-established goals.
- Initiates proactive measures that result in account resolution, including written and verbal claims, follow-up actions and first and second level appeals.
- Ensures all conditions for payment receipt have been satisfied, which includes; but not limited to:
- Accurate charges
- Patient insurance eligibility
- Accurate financial class
- Patient benefit coverage
- Authorization/certification/TAR information
- Patient responsibilities
- Claims address
- CPT coding, as applicable
- ICD-9 coding, as applicable
- Responds timely and accurately to all incoming related correspondence and inquiries from payers, patients and other authorized parties. Reports any trends in incoming correspondence to managers for appropriate follow-up.
- Interacts with co-workers and other representatives to obtain required information on a timely basis.
- Initiates contact with patient’s as necessary.
- Initiates recommendations and actions for resolving patient accounts. Evaluates accounts to determine any adjustments or charge corrections required.
- When required, submits bills to insurance for secondary insurance.
- Ensures that all necessary documentation and information is correct according to divisional policies and procedures and complete for submission of appeal.
- Research and prioritize incoming mail, resubmit denials with proper documentation according to divisional policies and procedures.
- Respond to all phone calls from other divisions or insurance companies in an efficient and courteous manner.
- Clearly document within the patient’s account, based on internal policies and procedures.
- Demonstrates teamwork and provides assistance with special projects when assigned.
- Maintains a positive image when dealing with department personnel and other City of Hope employees.
Basic education, experience and skills required for consideration:
- High school diploma or equivalent
- Minimum three (3) to five (5) years experience performing medical functions. Minimum experience including corresponding with patients and insurance companies in resolving patient accounts. Extensive knowledge of insurance carrier procedures. Experience with reading Explanation of Benefits (EOB) statements. Proven ability to handle multiple conflicting tasks.
- This position is represented by a collective bargaining agreement.
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