The Collector Appeal Specialist is responsible for accurately processing inpatient and out-patient claims to third party payers and private pays, following all mandated billing guidelines. Responsible for ensuring timely filing and guidelines are met; provided quality control checks on paper and electronic claims; process tracers, denial and related correspondence; initiate appeals; compose and submit appeal letters specific challengeable denial issues consistent with the most update American Medical Association Current Procedural Terminology. Must demonstrate a positive demeanor, good verbal and written skills, and must be professional in both appearance and approach. Will maintain consistent productivity standards as appropriate for their unit as well as maintain an average of 90% (score 9.0) or better on Quality Reviews.

The Professional Billing Refund Collector is responsible for accurately reviewing credit balances and processing adjustments, transfers and refunds as needed. Helps in billing operations by providing support and research of misapplied payments. Works as a member of the billing team to provide smooth operational flow resulting in optimum customer (internal/external) satisfaction and effective/efficient processes.

TYPE OF SUPERVISION RECEIVED: Direct supervision required. Daily, weekly and/or monthly Unit meetings may be required. Direct review of daily production and other production-based reports to validate staff usage needs, portfolio reduction efforts, customer services and staff morale.

Minimum Education: *High School or GED Minimum Experience/Knowledge: *2 Years of experience preferred. Combined education/experience as substitute for minimum experience. *Experience with medical services collections for any combination of payors (Medicare, Medi-Cal/Caid, HMO, PPO, Commercial, and Private Pay). *Excellent communication skills both written and oral, detail knowledge of applicable collection laws/policies/principles/etc., governing collection efforts, problem identification and resolution, insurance, medical terminology, and reimbursement procedures *Expert skill-level in specialty area. *Experience in computing environments. *User support experience with servers, operating systems, workstations, networks, LANs and network software. Required License/Certification: *N/A