Collector III: Revenue Cycle Operations

Job Description The Collector serves as the account representative for Hoag in working with insurance companies, government payors, and/or patients for resolution of payments and accounts resolution. Completes assigned accounts within assigned work queues. Obtains the maximum amount of reimbursement by evaluating claims at the contract rate with the use of the contract management tool for proper pricing (Examples: APC, DRG, APRDRG). Reviews and initiates the initial appeal for underpayments observing all timely requirements to secure reimbursement due to Hoag. Reviews and completes payor and/or patient correspondence in a timely manner. Escalates to the payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments. Reports new/unknown billing edits to direct supervisor for review and resolution. Has a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations & admissions) through Patient Financial Services (billing & collections), including procedures and policies. Has thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements. Interprets Explanation of Benefits (EOBs) and Electronic Admittance Advices (ERAs) to ensure proper payment as well as assist and educate patients and colleagues with understanding of benefit plans. Understands hospital billing form requirements (UB04) and is familiar with the HCFA 1500 forms. Possesses 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. Demonstrates knowledge of and effectively uses patient accounting systems. Documents all calls and actions taken in the appropriate systems. Accurately codes insurance plan codes. Establishes 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. Performs other duties as assigned. Consistently meets individual productivity and quality assurance standards. Performs other duties as assigned. Demonstrates proficiency in the functions of a Collector I & II. Strong knowledge of carrier’s (Federal/State/Private) regulations and guidelines. Assists peers and Supervisor/Manager with escalated situations. Actively participates in training and onboarding of new team members. Identifies ongoing training and recommendations for existing staff. Identifies and makes recommendations for development of processes or protocol changes. Exceeds individual productivity and quality assurance standards for at least 12 consecutive months. No corrective action within the last 12 months. Primary Duties and Responsibilities The Collector serves as the account representative for Hoag in working with insurance companies, government payors, and/or patients for resolution of payments and accounts resolution. Completes assigned accounts within assigned work queues. Obtains the maximum amount of reimbursement by evaluating claims at the contract rate with the use of the contract management tool for proper pricing (Examples: APC, DRG, APRDRG). Reviews and initiates the initial appeal for underpayments observing all timely requirements to secure reimbursement due to Hoag. Reviews and completes payor and/or patient correspondence in a timely manner. Escalates to the payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments. Reports new/unknown billing edits to direct supervisor for review and resolution. Has a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations & admissions) through Patient Financial Services (billing & collections), including procedures and policies. Has thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements. Interprets Explanation of Benefits (EOBs) and Electronic Admittance Advices (ERAs) to ensure proper payment as well as assist and educate patients and colleagues with understanding of benefit plans. Understands hospital billing form requirements (UB04) and is familiar with the HCFA 1500 forms. Possesses 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. Demonstrates knowledge of and effectively uses patient accounting systems. Documents all calls and actions taken in the appropriate systems. Accurately codes insurance plan codes. Establishes 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. Performs other duties as assigned. Consistently meets individual productivity and quality assurance standards. Performs other duties as assigned. Demonstrates proficiency in the functions of a Collector I & II. Strong knowledge of carrier’s (Federal/State/Private) regulations and guidelines. Assists peers and Supervisor/Manager with escalated situations. Actively participates in training and onboarding of new team members. Identifies ongoing training and recommendations for existing staff. Identifies and makes recommendations for development of processes or protocol changes. Exceeds individual productivity and quality assurance standards for at least 12 consecutive months. No corrective action within the last 12 months. Qualifications Education and Experience High school diploma or equivalent required. Five years' experience in a hospital/medical and or/related field. Working knowledge Epic Resolute, Epic Cer, and Epic CPOE and reporting. Working knowledge of MS Excel. Highly detail-oriented with proven ability to organize and prioritize assignments. License Required N/A License Preferred N/A Certifications Required N/A Certifications Preferred N/A About Us Hoag Memorial Hospital Presbyterian is a nonprofit regional health care delivery network in Orange County, California, consisting of three acute-care hospitals with sixteen urgent care centers, eleven health centers and a network of more than1,800 physicians, 100 allied health members, 8,000 employees, and 2,000 volunteers. More than 30,000 inpatients and 550,000 outpatients choose Hoag each year. For over 70 years, Hoag has delivered a level of personalized care that is unsurpassed among Orange County’s health care providers. Since 1952, Hoag has served the local communities and continues its mission to provide the highest quality health care services through the core strategies of quality and service, people, physician partnerships, strategic growth, financial stewardship, community benefit and philanthropy. Hoag offers a comprehensive blend of health care services including six institutes providing specialized care in the areas of cancer, heart and vascular, neurosciences, women's health, orthopedics, and digestive health through our institutes. Hoag was the highest ranked hospital in Orange County in the 2024-2025 U.S. News &World Report, the only Orange County hospital ranked in the top 10 for California. The organization was ranked the #5 hospital in the Los Angeles Metro Area and the #10 hospital in California. To learn more about Hoag’s awards and accreditations, visit: . Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives. #J-18808-Ljbffr Hoag Health System