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Accounts Receivable Specialist

2 months ago

Costa Mesa, California, United States BAHAMA Consulting Corporation Full time
Job Overview

POSITION: Collector I

LOCATION: Costa Mesa, CA (Onsite)

SCHEDULE: Full-time, 40 hours per week, 5 days a week, 8 hours a day.

SALARY: $28.00 per hour, dependent on experience.

This is the anticipated pay range that BAHAMA Consulting Corporation expects for this role.

ROLE SUMMARY: The Collector acts as the liaison for the healthcare facility, engaging with insurance providers, governmental payers, and patients to facilitate the resolution of payments and account discrepancies. Responsible for managing assigned accounts within designated work queues.

KEY RESPONSIBILITIES:

  • Maximizes reimbursement by assessing claims against contract rates utilizing the contract management tool for accurate pricing (e.g., APC, DRG, APRDRG).
  • Timely reviews and addresses payer and/or patient correspondence.
  • Escalates accounts requiring appeals due to incorrect billing, coding, or underpayments.
  • Reports new or unidentified billing edits to the supervisor for evaluation and resolution.
  • Possesses a comprehensive understanding of Revenue Cycle processes, from Patient Access (authorizations and admissions) to Patient Financial Services (billing and collections), including relevant procedures and policies.
  • Demonstrates thorough knowledge of managed care agreements, current payer rates, and an understanding of terms and conditions, as well as federal and state regulations.
  • Interprets Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to ensure accurate payments and assists patients and colleagues in understanding benefit plans.
  • Familiar with hospital billing form requirements (UB04) and knowledgeable about HCFA 1500 forms.
  • Understands various payor types including HMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation, and both commercial and government payors (e.g., Medicare, Medi-Cal, TriCare) and their claims processing methodologies.
  • Effectively utilizes patient accounting systems.
  • Documents all communications and actions taken in the appropriate systems.
  • May assess applicable cash rates, special rates, and relevant professional and employee discounts.

EDUCATION & EXPERIENCE:

  • High school diploma or equivalent is required.
  • One year of prior experience in a hospital business setting or a strong background in customer service is required.
  • Basic knowledge of insurance plans, hospital reimbursement practices, and/or ICD10 and CPT coding is preferred.

Benefits: Medical, Dental, Vision, HSA, Employee Assistance Program (EAP), STD, LTD, Life Insurance, and 401(K)

BAHAMA Consulting Corporation is an equal opportunity employer. If you require accommodation during the application and hiring process or have any inquiries, please reach out to HR.