Hospital Senior Collections Representative - Medi-Cal HMO

General Information

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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

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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

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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