Senior Collections Representative

%

of time

Essential Function (Yes/No)

Key Responsibilities

(To be completed by Supervisor)

75%

Yes

Revenue Cycle Functions

• Claim Submission: Incumbent to process paper and electronic claim forms to payors for chargeable and billable services. This includes resolving billing system edits (EDI/Charge Review) and determine the correction action to clear the error and produce clean claims for the Dental Center. Review key data within the claim form, such as provider, practice,, CDT/CPT, fee and ensuring appropriate documentation is included for adjudication.

• Correspondence: Reviews billing correspondence for timely resolution. This will include applying appropriate denial and claim status codes. The incumbent is responsible to recognize insurance reimbursement issues, coding problems and other issues that could affect the financial condition of the clinic. The incumbents work closely with the Revenue Cycle Director to resolve identified trends and problems.

• Accounts Receivable by following up and reprocessing claims as necessary. This includes research complex billing issues of each account; confirms primary and secondary payers, closely evaluates coordination of benefits; identifies appropriate contract / plan to provide payment for all phases of care.

  • Analyzes complex financial data and reports and identifies trends that contributes to aging accounts and common denials. Summarizes findings to share with management

  • Interpret and enters detailed account notes in order to understand past activity and to provide an audit trail for future follow-up.

  • Review Explanation of Benefits (EOB) and applying the appropriate denial, rejection, claim status codes, payment and or adjustment codes for timely resolution.

  • Manage the pursuit of unpaid or underpaid claims, including drafting and submitting appeals letter to payors or escalation letters to patients.

  • Initiates charge correction, refund and adjustment requests.

  • Use of the following reference tools and guidelines: MediCal Dental and Delta Dental Provider Handbook, UCSF Dental Center Fee Schedule, Contracted Fees, UCSF Dental Center Standard Work and Policies, CDT/CPT, ICD-9. HCPC Handbooks.

  • Adhere to the rules and regulations of the different types of medical and dental payers such as MediCal Dental, Delta Dental, PPO, EPO, HMO and commercial insurance.

Patient Billing Inquiries: Collaborates with clinic managers/supervisors and providers (faculty, residents, students) to resolve billing inquires in-person, phone, email, standard mail, etc in a timely and professional manner. Educate patients of personal financial responsibility and expectation. This involves and in depth understanding of the basic dental insurance policies and the ability to communicate effectively to patients and payors. Nurture the patient relationship to encourage patient retention and contribute to the development of a patient-focus environment. Establish relationships with external resources, provides extensive research to resolve billing inquiries which includes, but not limited to Patient Financial Servies, MGBS, Collection Vendor, Controller’s Office, etc.
Coordinate the resolution of bad debt patient outsource accounts with collection vendor.

• WQ Management: Monitor and manage revenue cycle related work queues in the EPIC system in a stratified manner. This includes, but not limited to, charge review, claim edit, account, remit, adj/refund review and ROI WQs. Resolve issues in a proactive manner by ensuring that all work queue items are reviewed, followed-up and appropriately closed.

• Payment Allocation: Preparation and submission of PeopleSoft journals for payments routing to PBS centralized Lockbox, MyChart deposits, ACH, EFT, i835 and insurance credit card, adhering to the Cash Handling Procedure Policy.

  • Incumbent must maintain PBS excel spreadsheets for reconciliation, statistical and audit purposes.

  • The incumbent prepares daily journals to transfer funds to the Dental Center Division General Ledger and record the information in the excel database. The excel reports are generated by the incumbents for the Division CAOs and Financial Analyst(s).

  • Initiates that all paper checks are transitioned to an electronic payment source.

  • The incumbent is responsible for the maintenance of the excel journal and deposit logs and the reconciliation of the monthly journals to ensure accuracy and completion against our weblinks reports. The SAS 112 reconciliation process is the responsibility of these employees.

Payor Enrollment: Submit and finalize provider applications to contracted payors. Collect provider supporting documents and ensure all forms are complete and signed. Keep abreast of the application requirements for each payor and individual providers recredentialing deadlines. Monitor and resolve payer-related delays and/or rejections and maintain accurate records to include submission history and effective dates.

25%

Process Improvement

• Contribute to the development of new administrative processes to streamline billing workflow and improve efficiency. This includes updating or providing systematic screenshots to develop written standard work and policies.

• Keeps abreast of changes in government regulations and requirements of all third party carriers. Drafts changes to systems, policies and procedures as needed.

• Use Epic Dashboards to monitor the status of work queues, identify aging accounts, and prioritize follow-up tasks for both patient balances and insurance claims. Analyze real-time data from dashboards to track key metrics such as days in accounts receivable, claim denials, payment posting, and account resolution times. Customize and filter Epic Dashboards to focus on specific work queues or account types (e.g., insurance claims, patient balances, or high-dollar accounts). Leverage dashboard filters to identify overdue accounts or insurance claims that require immediate attention.

• Drafts changes to systems, policies and procedures as needed.

• Provides back up as needed in all areas of the PBS, which requires cross training all functions within the revenue cycle.

• Assist in the development of training material on changes to systems or operational procedures.

• Assist management with specific tasks, training and special projects.

• Collaborates with Dental Center clinics, patients and outside stakeholders to resolve billing inquiries, including Patient Financial Servies, MGBS, Collection Vendor, Accounting, Controller’s Office, InstaMed, etc.

• Work independently within departmental guidelines, exercise appropriate judgement and function effectively as a member of the Patient Billing Service team.

• Prioritize workload and meet productivity, accuracy and meet service level/aging targets.

• Attend department, unit and other meetings as required.

• Complete trainings and University requirements within deadlines.

• Perform other duties as assigned.