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Collections Specialist

4 months ago

Costa Mesa, United States eTeam Full time

Job Title: Collector

Location: Costa Mesa, CA

Duration: 03+ months


  • The Collector serves as the account representati ve for Hoag in working with insurance companies,government payors, and/or patients for resolution of payments and accounts resolution.
  • Completes assigned accounts within assigned work queues.
  • Obtains the maximum amount of reimbursement by evaluating claims at the contract rate with the use of the contract management tool for proper pricing (Examples: APC, DRG, APRDRG).
  • Reviews and initiates the initial appeal for underpayments observing all timely requirements to secure reimbursement due to Hoag.
  • Reviews and completes payor and/or patient correspondence in a timely manner.
  • Escalates to the payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments.
  • Reports new/unknown billing edits to direct supervisor for review and resolution.
  • Has a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations admissions) through Patient Financial Services (billing & collections), including procedures and policies.
  • Has thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements.
  • Interprets Explanation of Benefits (EOBs) and Electronic Admitt ance Advices (ERAs) to ensure proper payment as well asassist and educate patients and colleagues with understanding of benefit plans.
  • Understanding of hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.
  • Knowledge ofHMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation,commercial and government payors (i.e. Medicare, Medi-Cal, TriCare, etc) and how these payors process claims.
  • Demonstrates knowledge of and effectively uses patient accounting systems.
  • Documents all calls and actions taken in the appropriate systems.
  • Accurately codes insurance plan codes.
  • Establishes a payment arrangement when patients are unable to pay in full at the time payment is due.
  • May review for applicable cash rates, special rates, applicable professional and employee discounts.
  • May process bankruptcy and deceased patient accounts.
  • Performs other duties as assigned.


Required Skills & Experience:

  • One year of previous hospital business experience, or equivalent required or strong background in customer service.
  • Basic experience with insurance plans, hospital reimbursement methodology, and/or ICD10 and CPT coding.