Sr. Commercial Collector

Houston Methodist; Houston (TX); In loco; USD 80.000 - 110.000; Tempo pieno

Descrizione del lavoro

Houston Methodist seeks a Senior Commercial Collector to protect the organization’s financial health by securing timely payments on high-dollar payer accounts and large queues. The role involves collaborating with insurance providers, reviewing contracts, and mentoring team members to improve collection outcomes.

Ideal candidates have extensive knowledge of claims reimbursement, managed care, Medicare/Medicaid, and strong communication skills to coordinate with patients, physicians, and staff

Competenze

• Five years of experience in commercial insurance follow-up, preferably in hospital accounts receivable.
• Extensive knowledge of claims reimbursement and collection efforts for Managed Care, Medicare, Medicaid, and other payors.
• Ability to interpret contracts and billing/collections processes.

Mansioni

• Ensure timely payments and maximize collection dollars on assigned accounts.
• Communicate with payors, patients, physicians, and staff with a customer-service focus.
• Provide guidance and mentoring to junior staff and collaborate with Insurance Provider Relation and third-party vendors.
• Monitor delinquent accounts and follow through on rebills and corrections as needed.

Conoscenze

Customer service

Communication

Negotiation

Analytical skills

Mentoring

Team collaboration

Formazione

High School diploma or equivalent

Descrizione del lavoro

At Houston Methodist, the Senior Commercial Collector position is responsible for ensuring that the organization's financial viability is protected at the most basic level by securing accurate and timely payments, working assigned higher dollar accounts, major/complicated payors, or large inventory work queues as directed. This position performs ongoing monitoring of assigned accounts to ensure maximization of collection dollars by providing appropriate follow-up and documenting actions taken. This position has direct contact with other Houston Methodist departments and insurance companies and takes a more participatory role in meetings and negotiations with Insurance Provider Relation and collaborations with third party vendors. The Senior Commercial Collector must demonstrate strong interpersonal and persuasive abilities in order to promote teamwork and cooperation as well as secure accurate and timely payment from third party payors. Other duties include serving as a resource, trainer, and mentor to other team members.

FLSA STATUS

Non-exempt

QUALIFICATIONS

EDUCATION

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)

EXPERIENCE

• Five years of experience in commercial insurance follow-up, preferably in hospital accounts receivable

SKILLS AND ABILITIES

• Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations
• Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
• Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
• Extensive knowledge of claims reimbursement and collection efforts for Managed Care, Medicare, Medicaid, Workers Comp, Commercial plans, etc.; knowledge of how to interpret a managed care contract, Medicare and Medicaid and Workers Compensation
• Extensive knowledge of billing, collections, reimbursement, contractual agreements and the appeals process
• Understanding of revenue cycle fundamentals
• Ability to follow-through and handle multiple tasks simultaneously
• Excellent communication and negotiation skills, as well as an ability to work independently and interdependently with other business office staff
• Good judgment in handling of accounts and ability to apply a professional approach in dealing with patients and insurance companies
• Sharp analytical abilities in order to resolve patient accounts in a timely and correct manner
• Proficient computer skills and ability to learn and navigate multiple software programs
• Ability to remain calm in stressful situations with patience and understanding
• Ability to approach problems with an open mind and contribute to solutions
• Strong training, leadership and mentoring skills

PEOPLE ESSENTIAL FUNCTIONS

• Promotes a positive work environment and contributes to a dynamic team focused work unit that actively helps one another to achieve optimal department and organizational results
• Strikes a balance between maintaining trustful relationships and ensuring timely payments. Exhibits professionalism and trustworthiness
• Serves as a resource and trainer for less experienced and new staff; orients, guides and mentors team members to help build confidence and competency in skills, knowledge and abilities

SERVICE ESSENTIAL FUNCTIONS

• Reviews incoming correspondence and takes appropriate action. Responds promptly to payor’s request for additional information/documentation. Confers with Billers, as necessary, to obtain additional information/clarification
• Takes a more participatory role in meetings and negotiations with Insurance Provider Relation and collaborations with third party vendors and projects
• Informs manager of payer trends or any problems or changes in payor requirements, including any barriers or obstacles

QUALITY/SAFETY ESSENTIAL FUNCTIONS

• Obtains corrected information and requests rebills as needed
• Provides clear and concise documentation of every action taken on an account in the system collection notes. Provides balance breakdown to document the status of next responsible party (i.e., primary, secondary payor, patient balance, or credit balance)
• Effectively manages inventory in accordance with departmental standards. Identifies accounts for advanced due diligence steps or legal placement
• Meets or exceeds stated Performance Indicator Expectations (e.g., productivity, account reviews, agings) as demonstrated on weekly Key Performance Indicator

FINANCE ESSENTIAL FUNCTIONS

• Follows up on assigned delinquent insurance claims. Ensures maximization of collection dollars from insurance companies in accordance with the respective contract and/or Houston Methodist financial arrangement. Works assigned higher dollar accounts, major/ complicated payors, or large inventory work queues as directed
• Analyzes accounts for errors, adjustments and credits, issuing corrected entries when necessary. Updates account information accordingly. Follows levels of authority for posting adjustments, refunds, and contractual allowances
• Uses resources effectively and efficiently. Organizes time effectively, minimizing incidental overtime, and sets priorities. Utilizes time between heavy workloads efficiently and helps other team members

GROWTH/INNOVATION ESSENTIAL FUNCTIONS

• Stays current on collection procedures of various payors and industry trends. Seeks opportunities to expand learning beyond baseline competencies with a focus on continual development
• Generates and communicates new ideas and suggestions that will improve quality or service. Demonstrates adaptability and flexibility in the face of changing demands

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

• Uniform: No
• Scrubs: No
• Business professional: Yes
• Other (department approved): Yes

ON-CALL

*Note that employees may be required to be on-call during emergencies (i.e. Disaster, Severe Weather Events, etc) regardless of selection below.

• On Call* No

TRAVEL

**Travel specifications may vary by department**

• May require travel within the Houston Metropolitan area No
• May require travel outside Houston Metropolitan area No

QUALIFICATIONS

EDUCATION

• High School diploma or equivalent education (examples include: GED, verification of homeschool equivalency, partial or full completion of post-secondary education, etc.)

EXPERIENCE

• Five years of experience in commercial insurance follow-up, preferably in hospital accounts receivable