Provides medical collection services for TLRA collection units. Utilizes a strong background as a medical collection specialist to successfully resolve accounts placed with TLRA for collection. This involves performing collection activities related to follow-up and account resolution, and includes communication to patients, clients, reimbursement vendors, and other external entities while adhering to all client, state and federal guidelines. Patient and client satisfaction is essential. Associates in the collection unites are expected to knave knowledge of the overall collection work processes for the both active AR and BD inventory.

MAJOR RESPONSIBILITIES

• Provides effective collection services, ensuring the successful recovery of accounts in accordance with client and state guidelines as well as TLRA's business objectives
• Documents and updates patient account information in TLRA's collection software system timely and accurately to include appropriate account status.
• Handles inbound patient and/or carrier calls promptly and professionally, providing assistance and resolution to account inquiries, issues and request.
• Uses collection tools effectively to ensure quality recovery services and meet or exceed established goals and work standards.
• Performs research and analysis of account issues and strives to resolve problems timely and accurately.
• Ensure daily productivity standards are met.
• Promotes positive patient relations by communicating in a manner that demonstrates respect for the human dignity of patients and/or their families.
• Performs other special projects as required when assigned.

Collections -- Insurance

•  Maintains actvie knowledge of all collection requirements by payors.
• Collects balance owing from third party payers in accordance with State and Federal laws governing collections practices. Ensures that colletion efforts are thorough with overall objective being to collect outstanding balances in an eithical manner.
• Ensures quality standards are met and proper documentation regarding patient accounting records.
• Contacts other departments to obtain necessary information for appeals, pending informaton and any other issues that impact and/or delay claim processing.

Collections -- Self Pay

• Ensures that self-pay accounts are handled in a customer service oriented manner that accomplishes the goal of collecting monies due to clients, while at the same time mperserving the positive image of TLRA that exists in the community.
• Responsible for assisting patients in identifying eligible means of financial assistance or if non apply working with the patient to make acceptable payment arrangements.
• Must be an effective team member with good communication skills. Must participate in team meetings, communicate work related ideas and concerns proactively and assist in finding appropriate resolutions.

Physician Billing/Collections

• Ensure proper reimbursement for all services and to ensure all appeals are filed timely
• Review accounts and determine appropriate follow up activities utilizing Six Sigma Practices
• Identify under and overpayments and take appropriate actions to resolve accounts
• Validate commercial insurance claims to ensure the claims are paid according to the contract
• Direct knowledge using Meditech and CollectLogix software
• Monitor and communicate errors generated by other groups and evaluate for trends

• HS Diploma or equivalency required
• Post HS education preferred
• Must have minimum of 3 years' experience in a Customer Service call enter environment with a focus on healthcare billing/collections or collection agency environment or 3 years' experience working in a client service or marketing capacity, preferably in a healthcare or collection agency environment.
• General hospital A/R accounts knowledge is required.
• PC skills in a Windows environment are required. Solid knowledge and utilization of desktop applications to include Word and Excel are essential.
• College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.