Collections Specialist I

Planned Parenthood of the Pacific Southwest is one of the largest providers of sexual and reproductive healthcare in Southern California, operating 20 health centers throughout our three-county region. Check out our new video, "We are Planned Parenthood of the Pacific Southwest” for more information about our organization: https://bit.ly/WeArePPPSW.

Care. No Matter What.

As the Collections Specialist I, you will have the opportunity to collect, post, and process encounter/account payments. This will include submitting claims and following up with insurance companies on unpaid amounts. In this exciting opportunity, you will communicate with patients and staff to provide a clear understanding of insurance benefits/eligibility, payment options, and patient financial responsibility. 

The ideal candidate will be dedicated to providing the highest level of customer service to stakeholders of all backgrounds and have the ability to handle sensitive situations with a strong intrapersonal savvy. If you have excellent problem solving skills, high attention to detail with a proven track record in meeting deadlines, and are driven by our mission, apply now!

This is a fully on-site role based in Mission Valley, San Diego. This role does not require nights or weekends.

• Prepare and submit clean claims to third party payers, either electronically or on paper, and work claim rejections.

• Verify insurance eligibility, benefits, and patient cost shares.

• Perform post-visit financial counseling with patients to ensure they are aware of their insurance coverage and financial responsibility. Explain complex insurance topics such as benefit coverages, copays, deductibles, and coinsurance.

• Negotiate payment plans for patients who cannot afford to pay cost of services in full.

• Serve as a patient advocate ensuring they are aware and take advantage of programs such as Medi-Cal, FamilyPact, and available sliding fee discounts.

• Analyze and process third party payments/adjustments.

• Determine the appropriateness of appealing denied claims, and take necessary actions to resubmit those claims on a timely basis.

• Work on aging and rebill reports; perform effective follow-up on unpaid claims using EPM tasking.

• Update EPM system with notes from conversations with patients, payers, Contact Center, and Health Center Staff. Ensure new or pertinent demographic information from patients is updated to ensure clean claim submissions to 3rd party payers.

• Answer questions from patients, internal customers, and insurance companies. Provide counseling to patients and Health Center staff on complicated insurance questions.

• Prepare, review, and send patient statements.

• Identify and resolve patient billing complaints.

• Perform various collection efforts including contacting patients by phone.

• Participate in educational activities and attend monthly staff meetings.

• 2+ years of recent third-party billing/coding/collections and/or Revenue Cycle process experience
• Knowledge of CPT & ICD codes
• Knowledge of PPO, HMO, IPA, MSO, and Medi-Cal billing practices & protocols
• Ability to read EOB’s and interpret carrier reimbursement

• Epic EMR experience
• Bilingual in Spanish

We are the power of Planned Parenthood.

We are Planned Parenthood of the Pacific Southwest, one of the largest and most prominent affiliates of the most iconic health care organization in the world. We are recognized for the wide array of services we provide and the outstanding education we deliver.

We are a prominent and powerful team of health experts who work relentlessly to help our communities sustain their health and well-being. We adhere to the highest standards and protocols as we collaborate and care for people, without judgment.

100 years of advocating for our mission has secured our advancement, our future and our passion for practicing health care.

We are a team you can have fun with and a powerful movement you can be part of. Together we’ll take pride in shaping the future of sexual health and reproductive rights.

For those who feel that purpose is critical to their work, this is a gift.

In This Together.

Planned Parenthood of the Pacific Southwest is an Equal Opportunity Employer.

Please visit our careers page for more information: www.pppswcareers.org