Accounting Software, Accounts Receivable, Analysis Skills, Billing, Centers for Medicare and Medicaid Services (CMS), Communication Skills, Credit and Collections, Customer Support/Service, Epic Resolute (Patient Accounting), Financial Services, Government, Government Regulations, Health Maintenance Organization (HMO), Healthcare, Healthcare Reimbursement, High School Diploma, Hospital, Insurance, Insurance Documentation, Managed Care, Medi-Cal, Medical Billing, Medicare, Microsoft Excel, Organizational Skills, Payment Posting, Preferred Provider Organization (PPO), Problem Solving Skills, Process Improvement, Quality Metrics, Reimbursement, Time Management
Peregrine Team is seeking an experienced Collector II to join a leading healthcare organization. This role is responsible for managing insurance and patient accounts, resolving outstanding balances, maximizing reimbursement, and ensuring accurate account resolution. The ideal candidate has a strong understanding of hospital revenue cycle operations, insurance billing, and collections.
Location: Open to local candidates in Costa Mesa, CA (on-site) or remote candidates residing in Georgia, Iowa, Indiana, Missouri, Nebraska, North Carolina, Tennessee, Texas, Utah, Wisconsin, or Wyoming.
Key Responsibilities:
- Manage assigned insurance and patient accounts within designated work queues.
- Follow up with commercial, government, and managed care payors to resolve outstanding claims and secure reimbursement.
- Review claims and payment activity to identify underpayments, denials, and reimbursement discrepancies.
- Initiate and manage appeals while meeting all filing and timely appeal requirements.
- Interpret Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to ensure accurate payment posting and account resolution.
- Research and resolve billing, coding, authorization, and payment issues.
- Communicate with insurance companies, patients, and internal departments to facilitate account resolution.
- Document all account activity, correspondence, and follow-up actions accurately within patient accounting systems.
- Establish payment arrangements with patients when appropriate.
- Maintain knowledge of managed care contracts, reimbursement methodologies, and government payor regulations.
- Assist with special projects, process improvements, and department initiatives as needed.
- Support team members through knowledge sharing, training, and problem-solving assistance.
- Consistently meet or exceed productivity and quality standards.
Required Qualifications:
- High school diploma or equivalent.
- Minimum 3 years of experience in hospital billing, healthcare collections, revenue cycle, medical accounts receivable, or a related healthcare financial services role.
- Experience with Epic Resolute, EpicCare, and Epic CPOE.
- Intermediate Microsoft Excel skills.
Preferred Qualifications:
- Strong understanding of insurance billing, collections, and reimbursement processes.
- Experience working with commercial, managed care, and government payors, including Medicare and Medi-Cal.
- Ability to interpret EOBs, ERAs, and insurance payment activity.
- Intermediate Microsoft Excel skills.
- Strong analytical, organizational, and problem-solving abilities.
- Excellent communication and customer service skills.
- Knowledge of UB-04 and HCFA-1500 claim forms.
- Understanding of HMO, PPO, POS, EPO, IPA, Medicare Advantage, Covered California, and capitated payment models.
- Experience handling denials, appeals, underpayments, and complex account resolution.
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