Managed Care Collector

Description

We are seeking a detail-oriented and experienced Medical Collector to join our hospital’s revenue cycle team. The ideal candidate will have a strong background in Medi-Cal and managed care collections, with a deep understanding of hospital billing practices and payer requirements. This role is critical in ensuring timely and accurate reimbursement for services rendered.

Key Responsibilities:

• Review and analyze patient accounts to identify outstanding balances and initiate collection efforts.
• Follow up with Medi-Cal and managed care payers to resolve unpaid or underpaid claims.
• Interpret Explanation of Benefits (EOBs), remittance advice, and denial codes to determine next steps.
• Submit appeals and corrected claims as needed to ensure maximum reimbursement.
• Communicate with patients, insurance companies, and internal departments to resolve billing issues.
• Maintain accurate documentation of collection activities in the billing system.
• Monitor aging reports and prioritize accounts based on payer deadlines and balance thresholds.
• Stay current with Medi-Cal and managed care billing guidelines and regulatory changes.

Qualifications:

• High school diploma or equivalent required; associate degree in healthcare administration or related field preferred.
• Minimum 4 years of experience in hospital medical collections, with a focus on Medi-Cal and managed care.
• Strong knowledge of CPT, ICD-10, and HCPCS coding.
• Familiarity with hospital billing systems (e.g., Epic, Cerner) and clearinghouses.
• Excellent communication and negotiation skills.
• Ability to work independently and manage multiple priorities in a fast-paced environment.

Preferred Skills:

• Experience with California Medicaid (Medi-Cal) and regional managed care plans (e.g., IEHP, LA Care, Health Net).
• Understanding of hospital revenue cycle workflows and compliance standards.

Skills

medical billing, collections medical, cms 1500, hospital billing

Top Skills Details

medical billing,collections medical,cms 1500,hospital billing

Additional Skills & Qualifications

Additional Skills & Qualifications

4+ years experience in hospital billing/collections most importantly medi-cal experience

Medi-cal collections and billing

Follow Up insurance calls

Data Entry

Hospital collections/billing

Experience Level

Intermediate Level