Collector I Jobs

Peregrine Team is hiring for a Collector in Costa Mesa, CA. This position is a full-time, contract to hire role with full benefits and competitive pay.

Job Duties:

• Reviews and completes payor and/or patient correspondence in a timely manner.
• Documents all calls and actions taken in the appropriate systems.
• Establishes a payment arrangement when patients are unable to pay in full at the time payment is due.
• 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).
• The Collector serves as the account representative for the hospital in working with insurance companies,government payors, and/or patients for resolution of payments and accounts resolution.
• Accurately codes insurance plan codes.
• Interprets Explanation of Benefits (EOBs) and Electronic Admitt ance Advices (ERAs) to ensure proper payment as well asassist and educate patients and colleagues with understanding of benefit plans.
• Demonstrates knowledge of and effectively uses patient accounting systems.
• May process bankruptcy and deceased patient accounts. Performs other duties as assigned.
• Completes assigned accounts within assigned work queues.
• May review for applicable cash rates, special rates, applicable professional and employee discounts.
• Has a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations admissions) through Patient Financial Services (billing & collections), including procedures and policies.
• Reviews and initiates the initial appeal for underpayments observing all timely requirements to secure reimbursement due to the hospital.
• Has thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements.
• 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.
• Reports new/unknown billing edits to direct supervisor for review and resolution.
• Escalates to the payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments.

Qualifications:

• 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.
• High school diploma or equivalent required.
• Shift: 40 hours- 5x8

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