Medical Collector

Planned Parenthood of Orange and San Bernardino Counties has a full-time opportunity for a Medical Collector in Anaheim, CA.

The Revenue Recovery Analyst identifies, collects, and determines root causes of underpaid claims by auditing payor performance and analyzing actual payments of payors to ensure contract compliance, which is operationally critical and sensitive in nature.

The Revenue Recovery Analyst will support the RCM collection team with training and escalated claim follow-up.

The Revenue Recovery Analyst performs payment variance deep dive and review activities related to the incorrect processing of claims across PPOSBC.

This position will focus on the resubmission, reprocessing, and correcting of denied or rejected/exhausted insurance claims (2nd Level) as well as all high-volume facilities, top payors, and high-level, complex claim issues.

At PPOSBC, we understand the importance of a well-rounded benefits program and are dedicated to providing you with unique benefits that meet the needs of you and your family.

We are proud to offer a range of plans that help protect you in the case of illness or injury including:


* A competitive benefits package including medical, dental, and vision coverage for you and eligible dependents, life insurance, and long term disability.


* Benefits coverage starts after one full month of employment!


* Generous vacation, sick, and holiday benefits!


* Generous 401(k) matching contributions and more!


* To view our detailed benefits guide, please visit our career site at www.pposbccareers.org

Responsibilities

Essential functions encompass the required tasks, duties, and responsibilities performed as part of the job and the reason the job exists.


* Utilize independent judgment and exercise discretion to ensure timely review and auditing of underpaid claims.


* Analyze, collect underpayments, and resolve claims with discrepancies from expected payment to ensure payors are in payment compliance with their contracted terms.


* Compile billing and payor documentation to create training documents.


* Initiate and follow through with all relevant parties to ensure corrective actions are implemented (i.e., pursue underpayments, adjust expected reimbursement, address billing issues, negotiate settlements, etc.) according to payor specific processes.


* Respond to payment discrepancies by creating appeal letters and articulating contract provisions to representatives from third-party payors.

Work directly with payor to recover payments.


* Quantify payor trends and maintain productivity and accuracy standards in a highly challenging environment.

Prepare second-level appeals, recoveries, and potential settlements.


* Ability to extrapolate complex claims data and payer information to accurately report trends and payor behaviors.


* Develops dashboards and reports on key performance indicators, metrics, data points, and formulas to support management object...