Collection Specialist

Software Guidance & Assistance, Inc., (SGA), is searching for a Collection Specialist for a Contract assignment with one of our premier Healthcare clients in San Leandro, CA.

Responsibilities : The PFS Collection Specialist is responsible for all aspects reviewing payer contracts, claims and performing third party collection activity for hospital services.

• Responsible for all aspects of follow up and collections on insurance balances, including making telephone calls, accessing payer websites. Identify issues or trending and provide suggestions for resolution. Accurately and thoroughly documents the pertinent collection activity performed. Review the account information and necessary system applications to determine the next appropriate work activity. Verify claims adjudication utilizing appropriate resources and applications. Initiate telephone or letter contact to patients to obtain additional information as needed. Perform appropriate follow-up functions, including manual re-submissions as well as electronic attachments to payers. Manage and maintain desk inventory, complete reports, and resolve high priority and aged inventory.
• Participate and attend meetings, training seminars and in-services to develop job knowledge. Participate in the monthly, quarterly and annual performance evaluation process with Supervisor. Respond timely to emails and telephone messages as appropriate. Communicate issues to management, including payer, system or escalated account issues.
• Maintains information or operational records; screens reports for completeness and mathematical accuracy; list, abstracts, or summarizes data; compiles routine report from a variety of sources.
• May, as a secondary responsibility, interpret abstracts, orders, notes, invoices, permits, licenses, etc.; computes and receives fees when the amount is not in question or is readily obtainable from fixed schedules; posts data; and prepares reports in accordance with pre-determined forms and procedures.
• Prepares documents for collection of revenues from third party payer programs; checks and verifies charge rates for services; reconciles account balances and verifies payments.
• Reviews billing documents to assure program compliance for Medicare, Medi-Cal, Mental Health, and insurance programs; assures that all appropriate medical documentation is submitted timely.

Required Skills:

• High school diploma or equivalent education.
• EPIC back-end experience
• Minimum Experience: One year of experience in a Revenue Cycle area within the Alameda Health System; OR the equivalent of two years' experience, performing medical billing/collections or medical accounts receivable functions in a healthcare insurance related environment.
• Intermediate computer skills including thorough understanding of the EHR system, Microsoft Office (Word, Outlook, Excel, PowerPoint).
• Intermediate knowledge of UB-04 and Explanation of Benefits (EOB) interpretation.
• Intermediate knowledge of CPT and ICD-10 codes.
• Intermediate knowledge of insurance claims and insurance terminology.
• Act in an appropriate and professional manner as defined by the company's Standards of Behavior, Policy and Procedures, and Scope of Services.
• Role model AHS Standards of Behavior.
• Current office administrative practices and procedures.
• Correct business English, including spelling, grammar and punctuation.
• Use independent judgment and initiative within established policies and procedures.
• Establish and maintain effective working relationships with a variety of individuals from various socioeconomic, ethnic and cultural backgrounds.
• Should have a good understanding of payer contract language, and how to apply language to reimbursements.
• Excellent communication skills, both written and verbal.

Preferred Skills:

• 3-5 years of experience in a hospital business environment performing billing and/or collections. No certification requirement however someone with a strong background in collection and patient accounting (medical billing).

SGA is a technology and resource solutions provider driven to stand out. We are a women-owned business. Our mission: to solve big IT problems with a more personal, boutique approach. Each year, we match consultants like you to more than 1,000 engagements. When we say let's work better together, we mean it. You'll join a diverse team built on these core values: customer service, employee development, and quality and integrity in everything we do. Be yourself, love what you do and find your passion at work. Please find us at .

SGA is an Equal Opportunity Employer and does not discriminate on the basis of Race, Color, Sex, Sexual Orientation, Gender Identity, Religion, National Origin, Disability, Veteran Status, Age, Marital Status, Pregnancy, Genetic Information, or Other Legally Protected Status. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, and our services, programs, and activities. Please visit our company EEO page to request an accommodation or assistance regarding our policy.