Hospital Senior Collections Representative - Medi-Cal HMO

UCLA Health • Los Angeles, CA, United States • $200k - $250k / year • 3h ago

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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