Job Description SUMMARY STATEMENT: Follow-up Credits Collector The credit collection representative reviews Medi-Cal Fee for Service credit balances. Validates Medi-Cal credit balances, post adjustments and requests transfer of the incorrectly applied payments to the appropriate account and/or Liability bucket; reviews Medi-Cal RA’s in a timely manner so that account is expedited through the collection flow. The Representative is responsible for reviewing assigned inpatient and outpatient claims to ensure maximum collection dollars were paid by providing appropriate review and documenting actions taken. His/her major functions include managing a portfolio of assigned accounts, filing CIF’s to ensure timely account resolution. The follow-up collector must have the ability to perform all needed duties in the patient accounting systems. Skilled in the usage of all Microsoft and other programs as defined by the Patient Business Services Management Staff. TYPE OF SUPERVISION RECEIVED : Daily meetings as needed. Also weekly Unit meetings and monthly Division meetings; Direct review of daily production and other production based reports in an effort to validate staff usage needs, portfolio reduction efforts, customer services and staff morale. Amount of Time Duties and Tasks Rating Comments D M E ADMINISTRATIVE DUTIES: Follow-up /Collections as a Primary portfolio assignment. Understands billing / follow up and collection procedures and is able to balance all accounts correctly. Follows-up on previously billed accounts by reviewing accounts on a biweekly or monthly basis to determine possible sources of payment or payment problems. Demonstrates ability in taking logical, decisive steps towards account resolution. Contacts other medical center departments (i.e., Admission, Utilization Review, Medical Records) to gain information necessary to adequately address payment issues. Contacts patient to obtain involvement to provide missing documentation, to track delayed insurance payment and/or to collect patient liability portion of bill. Forwards statements and/or form letters to patients advising of account status and indicating any action, which need to be taken. Reviews and maintains ‘portfolio’ of accounts responsible for, with optimum cash collections, adjustments, Credit resolution and closures. Resolves accounts in the aging category by collecting cash and/or applying appropriate adjustments in a timely manner. File/Account Documentation: Documents all activity taken on account in system notes Writes clear, concise and grammatically correct folder notes Makes necessary adjustments using the correct CDM transaction codes (credit or debit) in order to correct account balance and/or misapplied payments. Updates case / payor data and requests rebills as necessary. Bills primary and secondary third party carriers per designated procedural guidelines when necessary or assigned. INSTITUTIONAL AND/OR PROFESSIONAL STANDARDS Complies with regulatory agencies, and institutional and operating systems. Adheres to all Hospital Policies and Procedures as they apply to the area. Knowledge and adherence to Infection Control and Environment of Care Guidelines and Procedures as they are described in the annual education module Protects patient/customer confidentiality. PERFORMANCE IMPROVEMENT Adheres to current organizational Performance Improvement priorities. Participates in quality studies through data collection. Makes recommendations and take actions to improve structure, system or outcomes. CUSTOMER SERVICE Demonstrates the values of the organization: respect, honesty, integrity, compassion, fairness, innovation and stewardship of our resources. Demonstrates commitment to serving the customer. Demonstrate excellence in communication with the customer. Creates a welcoming environment for the patients, family and other interdisciplinary team customers. OTHER DUTIES Maintains and submits productivity statistics daily to the Division Supervisor. Maintains consistent productivity in follow-up and meets the Divisions Production average # of accounts worked on a per hour, per day, per week and per month basis. Maintains an open line of communication with the management staff at all times. Advises the management staff of all work-related issues, problems and concerns. Responds to management requests and / or assigned projects within the provide time. Follows Manager’s and or Supervisor’s directives and guidelines when processing all duties, tasks and work assignments. Adheres to and follows the departmental guidelines on the usage of all University Equipment. Complies in using the telephone for the main purpose of contacting patients and insurance carriers. Utilizes Computers (access to the Internet), Copiers and Fax machines for the sole purpose of work related processes. Adheres and follows departmental guidelines in the areas of punctuality, attendance and utilization of sick time. Reports to work on time every morning. Reports to work on time after breaks and lunch periods. Meets the departmental guidelines regarding the utilization of sick time {not to exceed an average of (8) hours per month over any rolling six-month period}. Calls the management staff regarding any absence(s) prior to the start of the scheduled shift. Assists in special projects or other assignments as needed. Demonstrates positive feedback; volunteers for additional work or overtime projects. Meetings, general support to other areas and office activities. Training classes.