Description
The Government Collections Lead will be responsible for assisting the Collections Supervisor. Organize and manage the daily activities for Government payers, including being compliant with all requirements and oversight, timely completion with monthly or quarterly credit balance reporting. The Lead will monitor staff's daily productivity and quality goals. Perform frequent and thorough quality assurance audits to ensure accounts are worked in accordance with the department work standards. Provide feedback and training to staff to reduce errors found during the audit process. Be accessible to answer staff questions and ensure all actions are compliant with National Billing practices and standards. Assist the team's Supervisor with training, new hires, and perform weekly chairside training with all staff as needed. Government Collection Lead will also be responsible to assist the Collection Supervisor with Medicare/Medi-Cal cost reports, Government audits and other duties as assigned. The Government Collections Lead will also assume duties as a Collector as needed, such as but not limited to, managing patient accounts from the point of authorization initiations, approval and initial claim submission through final resolution. Identify and address recurring denials by contacting DHCS , or other government agencies and ensure account balances are correct based on payer contract terms. The Government Collections Lead is responsible for their assigned work queues, possess and maintain knowledge of payer specific rules and guideline related to collection requirements. Perform necessary follow-up to obtain the appropriately owed reimbursement for Hospital services. Lastly, they will be responsible for all other duties as assigned.
Essential Duties:
- Gather, organize and disseminate information related to productivity and department operations to team members.
- Ensure that directives are understood and carried out by staff by providing coaching and training as needed.
- Assist staff with escalated accounts.
- Perform weekly quality reviews on accounts assigned to Collectors via VQ to ensure standard collections processes are followed, and provide constructive feedback.
- Provide ongoing support and development for team members, webinar education, updates, and assisting in department operations and training for current staff and new hires.
- Respond to staff questions timely and with accurate instructions that are in line with internal policy.
- Perform coaching with staff as needed to ensure all team members are achieving or exceeding departmental goals.
- Resolve and follow up on any account/ denials.
- Monitor and identify opportunities for process improvement related to government Billing Collections, and Department Operations, and determine the root-causes.
- Provide Department Leaders with solutions to resolve payer issues. Assist with the development of Job aids and new processes.
- Run and analyze AR reports via various internal applications, to identify government denial payer trends. Target areas of opportunity to increase cash collections.
- Properly calculate reimbursement amounts based on MSDRG, APDRG and Fee schedules, to ensure maximum payments are received for all services provided. Including appeals, Claims inquire Forms, government system inquiries when denials are received.
- Read, understand, and apply payer contract terms to accounts receivable.
- Maintain knowledge of reimbursement methodology.
- Ensure correct payment has been received from payers.
- Respond to inquiries related to government payor take backs/ cancel claims, appeals, and claims inquiry forms within the established timeline of 5 days from receipt.
- Assist with escalation of claims to HIM and other Internal Departments for resolution.
- Read and understand CMS rules and guidelines when applying to government payor's Billing and Collections processes.
- Enter detailed documentation to record follow-up activity on patient accounts.
- Maintain a detailed understanding of the payer matrix of financial responsibility.
- Assist with monthly or quarterly credit balance reports for government payors.
- Perform Other duties as assigned.
Required Qualifications:
- Req High School or equivalent
- Req 5 years Prior management in Hospital A/R billing, A/R follow up, and collections.
- Req Must possess strong knowledge of hospital registration, insurance billing, and overall AR management.
- Req Strong written and verbal communication skills.
- Req Ability to supervise, organize and multi task and achieve results through others.
- Req Strong interpersonal skills. Requires contract knowledge and interpersonal skills.
- Req Must interface with departments of patient concerns and/or charging matters.
Preferred Qualifications:
- Pref Bachelor's Degree In related field.
Required Licenses/Certifications:
- Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)
The hourly rate range for this position is $25.00 - $39.69. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
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