Description 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.
- Communicating with insurance providers, patients, and internal departments to gather crucial information and address payment challenges promptly and efficiently.
- Optimizing account management efficiency and ensuring timely resolution within the revenue cycle, driving the organization's financial success.
Salary Range: $32.24 - $46.29/hourly
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.
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