The Biller / Collector is responsible for the follow-up performed on accounts to ensure payment with delay is received from insurance, patients or other payers.  Communicates clearly and efficiently by phone and in person with the patient, insurance and staff members.  Maintains productivity standards and reports billing issues appropriately.  Obtains updated demographic information and all necessary information needed to comply with insurance billing requirements.  Forwards updated information to responsible staff members for computer changes.  Operates computer to input follow up notes and retrieve collection and patient information.

Under the supervision of the Director, the Payment Review Specialist position is responsible for accurate and timely payment analysis of managed care contracts to determine that appropriate reimbursement is received. Utilizing many complex and varying regulations, guidelines and systems, analyzes payments received from insurance companies to assure maximum and correct reimbursement of Hospitals receivables. Proactively works with payers and in-house resources to identify and resolve issues that hinder optimal and correct account payment. Utilizes and applies the appropriate State and Federal regulations in order to assure compliance in payment practices.

The Medical Group Urgent Care Manager is responsible for planning, organizing and influencing department activities and delivery of services while maintaining continuous quality improvement. The Medical Group Urgent Care Manager maintains operations within budgetary parameters. Effectively interacts with patient, physicians, and other health team members while maintaining standards of professional business conduct and service. The Medical Group Urgent Care Manager is accountable to the Operations Manager and Executive Director for the day-to-day management of personnel, including staffing, credential monitoring, timekeeping, employee evaluation, counseling, interview and selection of staff within established SMMG and regulatory guidelines. The Medical Group Urgent Care Manger spends 80% + of his/her time is spent on the management activities. This role oversees 2 more clinics.

Primary Representative in Managed Care Negotiations. Evaluates and constructs Managed Care Contract Language.Assesses and structures rate reimbursement levels for Managed Care Contracts. Primary representative with Managed Care Entities for collection efforts. Primary resource within organization relating to Managed Care and Medi-Cal and helps to negotiate Medi-Cal Contracts and Supplemental Funding. Negotiates contractual relationships and assists in implementation of contractual relationships with the CDRC. Assists Business Offices in Collection efforts with Managed Care Entities and Medi-Cal. Represents organization with various trade groups (i.e. UHA, CHA, etc.)Assists Finance Department in projects assigned and disproportionate Share.Assists and Develops relationships with Governmental Agencies and Managed Care Entities. Assists Legal Department in Collection Efforts and preparations for Legal Response as requested.Assists Collection Department in Collection efforts with Managed Care Entities. Monitors and assists in the Management of Capitated Programs. Develop, implement, monitor and manage the local operations necessary to achieve delegation of duties with our Medicare Advantage partnership. Support local market presence and provider relations for Employee Health Plan, working collaboratively with Prime Healthcare EHP team to maximize benefit coverage while containing costs.

The referral coordinator is responsible for referral operations at assigned clinics, establishing and standardizing systems and procedures for the distribution and use of health information throughout the organization, coordinating and referral functions with all other departments. Referral coordinators are responsible for ensuring that all patient and accounts are financially secure by means of verification of insurance information, authorization of procedures, validating of patient demographics

The Collector is responsible for the follow-up performed on insurance balances or self pay accounts to ensure payment without delay is received from the insurance companies or uninsured patients or the account is converted to another financial payer. Communicates clearly and efficiently by phone and in person with our clients and staff members. Maintains productivity standards and reports. Obtains updated demographic information and all necessary information needed to comply with insurance billing requirements. Forwards updated information to responsible staff members for computer changes. Operates computer to input follow up notes and retrieve collection and patient information. Is able to write effective appeals to insurance companies.