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Description

We are looking for a Medical Collections Specialist to join our team in Costa Mesa, California. The role will focus on working with insurance companies, government payors, and patients for the resolution of payments and accounts. The successful candidate will be responsible for evaluating claims, initiating appeals for underpayments, reviewing and completing payor and patient correspondence, and documenting all actions taken in the appropriate systems.

Responsibilities:

• Evaluate claims at the contract rate for proper pricing

• Initiate the initial appeal for underpayments

• Review and complete payor and patient correspondence in a timely manner

• Escalate to the payor and patient accounts that need to be appealed due to improper billing, coding, and underpayments

• Report new/unknown billing edits to the supervisor for review and resolution

• Demonstrate a strong understanding of the Revenue Cycle processes, including patient access (authorizations & admissions) through patient financial services (billing & collections)

• Exhibit thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements

• Interpret Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to ensure proper payment

• Understand hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms

• Demonstrate 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

• Accurately code insurance plan codes

• Establish a payment arrangement when patients are unable to pay in full at the time payment is due

• May review for applicable cash rates, special rates, applicable professional and employee discounts

• May process bankruptcy and deceased patient accounts.

Requirements • Proficiency in customer service and maintaining high customer satisfaction levels

• Ability to manage and maintain accurate documentation

• Proficiency in Microsoft Excel

• Experience in training team members or staff

• Understanding of procedures and policy implementation related to collections

• Experience in payment processing and cash activity management

• Strong research and planning process skills

• Ability to review and provide workstation support

• Knowledge of medical coverage, pricing, and benefit functions

• Experience in billing and collection processes

• Skill in correspondence and claim administration

• Ability to maintain high productivity levels

• Willingness to travel as required for the role

• Understanding of clinical trial operations and coding

• Experience in managing authorizations.

Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.

All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.

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