Collector I

Job Title: Collector I Location: Costa Mesa, CA Duration: 06 months+ (High possibilities of extension) Pay Range: $30/hr - $33/hr on W2 (Negotiable) Position Summary: · The Collector serves as the account representative ve for Client 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 Client. · 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 Admittance Advice (ERAs) to ensure proper payment as well as assist 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 of HMO, 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. ·         Must have strong medical collector experience. ·         Basic experience with insurance plans, hospital reimbursement methodology, and/or ICD10 and CPT coding.   Preferred Skills: ·         Epic Hyperspace is preferred, but not required

Created: 2025-06-05