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General Information

Work Location: Los Angeles, USA
Onsite or Remote
Flexible Hybrid
Work Schedule
Monday - Friday, 7:30 AM - 4:00 PM
Posted Date
06/12/2024
Salary Range: $32.24 - 46.29 Hourly
Employment Type
2 - Staff: Career
Duration
Indefinite
Job #
15351

Primary Duties and Responsibilities

The Hospital Senior Collections Representative - Medi-Cal HMO manages a specific portfolio of inpatient and outpatient claims to maximize collection outcomes. Key responsibilities include:

  • Conducting comprehensive and strategic account reviews.
  • Leading efforts to resolve reimbursement discrepancies with third-party payers.
  • Implementing proactive follow-up strategies to expedite account resolution.
  • Communicate with insurance providers, patients, and internal departments to gather crucial information and address payment challenges promptly and efficiently
  • Optimize account management efficiency and ensuring timely resolution within the revenue cycle, driving the organization's financial success. 

Salary Range: $32.24 - $46.29/hourly

Job Qualifications

We are seeking a self-directed, detail-oriented individual with: 

  • High school diploma or General Education Diploma (GED).
  • Five or more years of progressive experience in collections, including extensive expertise in complex collections investigations and resolution.
  • Experience in Medi-Cal HMO Collections, highly desired 
  • Thorough understanding of UB04 requirements and advanced knowledge of medical billing processes, including proficiency in navigating Medicare and Medicaid regulations
  • Ability to interpret and apply payer contracts, skillfully negotiate payment terms, and successfully process contractual adjustments.
  • Advanced proficiency in analytical tools and software, particularly Excel/spreadsheets, for detailed data analysis and reporting.
  • Deep knowledge of collection techniques, laws, and regulations, including AB1455, Knox-Keene Act, Health & Safety Codes, and other relevant statutes
  • Extensive familiarity with medical terminology, CPT codes, HCPCS codes, and diverse healthcare networks such as IPAs, HMOs, PPOs, PCPs, and contract affiliations
  • Exceptional verbal and written communication skills, adept at effectively communicating with diverse stakeholders and presenting complex information in a clear and concise manner.
  • Advanced proficiency in the Microsoft Office suite, specifically Excel and Word