Commercial Hospital Collections Representative

Commercial Collections Representative

Work Location: Los Angeles, CA, USA

Onsite or Remote Flexible Hybrid Work Schedule Monday - Friday, 7:30 AM - 4:00 PM

Salary Range: $27.65 - $39.27 Hourly

Employment Type 2 - Staff: Career Duration Indefinite

Primary Duties and Responsibilities

As a Commercial Collections Representative, you will manage a designated portfolio of inpatient and outpatient claims, ensuring effective and efficient collection efforts. Your primary responsibilities include:

• Conducting regular account reviews to identify outstanding balances.
• Initiating and maintaining communication with third-party payers to resolve reimbursement discrepancies.
• Diligently following up on claims to ensure timely resolution.
• Communicate with insurance providers, patients, and internal departments to gather necessary information and resolve payment issues.

Job Qualifications

We are seeking a self-directed, detail-oriented individual with:

• High school diploma or GED; Minimum of 3 years of relevant experience, including at least 1 year in collections investigation
• Experience in commercial and managed care collections, highly desired
• Ability to interpret payer contracts and process contractual adjustments
• In-depth knowledge of UB04 requirements and medical billing processes
• Strong analytical skills and proven proficiency in Excel and spreadsheets
• Understanding of collection techniques and laws, including AB1455, the Knox-Keene Act, Health & Safety Codes, etc., Familiarity with medical terminology, CPT codes, HCPCS codes, health networks, IPAs, HMOs, PPOs, PCPs, and contract affiliations
• Excellent verbal and written communication skills
• Proficiency in Microsoft Office, especially Excel and Word
• Exceptional organizational skills, with the ability to meet deadlines, work independently or as part of a team, and prioritize tasks effectively