Job Description
Collector I\n
Location: Costa Mesa, CA 92626
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Assignment: 3 months - Possible of extension
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Schedule: Monday–Friday, 7:00 AM–3:30 PM PST
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Pay Rate: $33/hour
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Required System Experience: EPIC Hyperspace
Position Summary\n
The Collector I serves as an account representative working with insurance companies, government payors, and patients to resolve outstanding payments and accounts.
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The Collector is responsible for managing assigned accounts, maximizing reimbursement, reviewing claims and payments, initiating appeals, and ensuring accounts are resolved accurately and within required timelines.
Key Responsibilities\n
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- Manage and resolve assigned patient and insurance accounts within designated work queues.
- Review claims and determine appropriate reimbursement using contract rates and contract management tools, including APC, DRG, and APR-DRG methodologies.
- Identify underpayments and initiate initial appeals within applicable filing and appeal deadlines.
- Review and respond to insurance company and patient correspondence in a timely manner.
- Escalate accounts requiring appeals due to improper billing, coding issues, or underpayments.
- Report new or unidentified billing edits to the appropriate supervisor for review and resolution.
- Apply knowledge of the healthcare revenue cycle, including Patient Access, authorizations, admissions, billing, and collections.
- Interpret Explanation of Benefits (EOBs) and Electronic Remittance/Admittance Advices (ERAs) to verify proper payment.
- Assist patients and colleagues in understanding insurance benefits and payment responsibilities.
- Apply knowledge of UB-04 hospital billing requirements and familiarity with HCFA-1500 forms.
- Work with various insurance and government payors, including:
- HMO
- POS
- PPO
- EPO
- IPA
- Medicare Advantage
- Covered California/Exchange
- Capitated plans
- Commercial insurance
- Medicare
- Medi-Cal
- TRICARE
- Accurately document calls, account activity, and actions taken in the appropriate systems.
- Accurately code insurance plan information.
- Establish payment arrangements for patients who are unable to pay balances in full when due.
- Review applicable cash rates, special rates, professional discounts, and employee discounts when appropriate.
- Process bankruptcy and deceased-patient accounts when assigned.
- Perform other duties as assigned.
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Required Qualifications\n
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- High school diploma or equivalent.
- At least 1 year of previous hospital business experience, equivalent experience, or a strong customer-service background.
- Basic knowledge of insurance plans and hospital reimbursement methodologies.
- Basic understanding of ICD-10 and CPT coding.
- EPIC Hyperspace experience is required.
- Strong communication, organization, documentation, and customer-service skills.
- Ability to work independently and manage assigned account queues.
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