Claims/HMO Risk Collector

Are you looking for a company that you can rely on? At Prospect Medical we understand how important it is to be taken care of. With 20 years in the business and now managing 13 IPA’s, we offer stability and reliability.

Prospect Medical is Southern California’s 3rd largest IPA---and growing! Come join our team of dedicated professionals committed to providing quality service and quality care to our 1500+ primary care and 9000 specialist physicians and to our 250,000+ members.

 

Prospect recognizes that you have unique goals, dreams and ambition. That’s why we go out of our way to understand and share your vision.

 

 Prospect is looking for an ideal candidate to fill the

Claims/HMO Risk Collector position:



Job Purpose:

Seeking an energetic, organized, and experienced individual to be a Claims/HMO Risk Collector.  The Claims/HMO Risk Collector will be responsible for contacting providers and health plans to get status on overpayment requests and cap deduction status. The Claims/HMO Risk Collector will also be responsible for analyzing reports and collecting past due overpayment accounts. Furthermore, this individual will be responsible for special Claims Recovery projects.

 

Essential Functions:



·  Ability to actively make collection calls on current and past due overpayment accounts.

·  Provide analysis and reports on recovery status

·  Analyzing overpayment letters and payment accounts to providers

·  Responsible for correspondence with health insurance companies in regards to cap deductions

·  Provide weekly and monthly Recovery reports to Manager

Skills/Qualifications: The ability to work independently with minimal supervision.Proficient in Excel to include the ability to create and update an Excel spreadsheet for purposes of tracking and reporting.Excellent verbal and written communication skills with emphasis on CollectionsMedical Claims processing or Claims related experience Knowledge of AB1455 and CMS guidelines

Education and/or Experience: A High School Diploma or Equivalent BS/BA preferred. Two years of college or comparable or equivalent to 2 years within healthcare industryOne to two years experience in collections.Thorough knowledge of PC usage is required.

 LANGUAGE SKILLS

·  The ability to speak, read, and write English proficiently.

·  The ability to write business correspondence effectively.

·  Must possess the ability to effectively present information and respond to questions from managers, employees, clients, customers and the general public.

 

 

 Prospect Medical has a solid past and a dynamic future.  Nearly 20 years old, we have grown and matured---we are now publicly-traded (AMEX:PZZ), IPA and medical management services company.  We contract with all major regional HMO’s including PacifiCare, Blue Cross, Health Net and CIGNA.  We are now serving California’s seniors with a superior Medicare program, and we are pursuing additional growth through a strategy of targeted acquisition.  We succeed through the use of superior technology, proven management procedures, and committed employees. Our success allows us to offer excellent compensation and one of the best benefit packages in the industry.

If you are a qualified, high-achieving professional who wants to make a positive difference in the world of managed care,
please submit your resume online.

 

Quality Service, Quality Care…that’s who we are!

 

Looking for a great company who cares, then you should call Prospect today!

Please visit our website for more information and a listing of all our open positions
www.prospectmedicalholdings.com