Medical Collection Specialist (Onsite)

Job Description

We're looking for a Medical Collections Specialist who will be responsible for processing high volume of medical collection, review and initiate the initial appeal for underpayments, and establish payment arrangements with patients.

Details :

• Pay : $20-$29 DOE
• Location : Cost Mesa- % Onsite
• Must have EPIC experience!
• Must have high volume medical collections experience.
• Attendance is key to success! Looking for committed individuals!

Position Summary :

• The Collector serves as the account representative 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 as assist and educate patients and colleagues with understanding of benefit plans.
• Understanding of hospital billing form requirements (UB04) and familiar with the HCFA 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.

Required Education :

High school diploma or equivalent required.

Interested? Apply today! If you meet the qualifications, a team member will reach out!

Wollborg Michelson Recruiting is an Equal Opportunity Employer and prohibits discrimination of any kind. We ensure job offers are made based of one’s employment experience, skills, and qualifications, regardless of race, gender, ethnic origin, or any other classification protected by law.

All applicants must furnish proper identification to prove their legal right to work in the US upon a job offer. We participate in E-Verify to confirm one’s right to work in the US.

Wollborg Michelson Recruiting does not provide sponsorship for an employment-based visa status. All applicants must also provide proof of COVID Vaccination when requested, except where prohibited by law.

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