Collections Representative

Collections Representative Government Billing

Location: Hybrid. Will train onsite at 10920 Wilshire Blvd Suite 1600, Los Angeles, CA. Once trained, will work remotely Duration: 17 weeks to cover LOA

Position Summary: The Collections Representative Government Billing is responsible for the accurate and timely billing of inpatient, outpatient, and laboratory claims to government and third-party payers. This role ensures compliance with payer regulations, billing guidelines, and timely filing requirements while maintaining account accuracy and maximizing reimbursement.

Minimum Qualifications

• High school diploma or equivalent required.
• 2-5 years of experience in Medicare Billing and collection for inpatient and outpatient
• Proficiency with standard office equipment and computer applications.

Key Responsibilities

• Claims Billing & Processing
• Review and analyze accounts to determine appropriate billing procedures based on payer type, financial class, and claim requirements.
• Prepare, review, and submit electronic and paper claims in accordance with federal, state, payer, and organizational guidelines.
• Verify claim accuracy, including demographics, charges, authorizations, coding, and supporting documentation.
• Research and obtain missing information from internal departments and external sources as needed.
• Monitor and resolve claim edits, rejections, denials, and billing exceptions.
• Submit required supporting documentation, including authorizations, medical records, consent forms, and payer-specific forms.
• Ensure compliance with timely filing requirements and payer regulations.
• Identify and bill capitated services to the appropriate responsible party.
• Maintain claim management systems and resolve claim scrubber edits and billing holds.
• Account Maintenance & Adjustments
• Process account corrections, adjustments, transfers, rebills, and write-offs according to departmental procedures.
• Update payer, case, and account information accurately and document all actions taken.
• Submit adjustment requests requiring management approval when applicable.
• Maintain accurate account notes and billing documentation within patient accounting systems.
• Documentation & Compliance
• Document billing activity, claim details, expected reimbursement, payments, and account actions clearly and accurately.
• Protect patient confidentiality and comply with HIPAA and organizational privacy standards.
• Adhere to all regulatory requirements, hospital policies, and billing compliance guidelines.
• Quality & Performance
• Maintain established productivity and quality standards.
• Monitor accounts to ensure timely claim submission and follow-up.
• Communicate billing issues, trends, and operational concerns to leadership.
• Participate in performance improvement initiatives and process enhancement efforts.
• Support special projects and departmental objectives as assigned.
• Customer Service
• Provide professional and courteous service to patients, payers, and internal stakeholders.
• Demonstrate effective communication and problem-solving skills.
• Foster positive working relationships across departments and with external partners.

Required Knowledge & Skills

• Knowledge of hospital billing practices, government payer regulations, and managed care contracts.
• Experience with electronic claims processing and patient accounting systems.
• Proficiency in Microsoft Office applications, including Word and Excel.
• Strong analytical, organizational, and problem-solving skills.
• Ability to manage multiple priorities and meet productivity and quality expectations.
• Knowledge of healthcare billing software and payer portals preferred.