Medical Collections Specialist II (Hyrbrid)

Job Description

Job Description

A nationally recognized Hospital in Los Angeles is in the immediate need of a Medical Collector II. The Medical Collector II must be well versed with insurance collections preferably from Medi-Cal/Medicaid and CCS (California Children’s Services). The Medical Collector II is responsible for analyzing denied claims and appeal accordingly. The Medical Collector II also performs a variety of duties which may include answering in-coming telephone calls, documenting insurance information, verification of eligibility and billing/appealing claims to the various insurance carriers. This position is responsible for handling patient accounts in a high-performance team environment with a number of additional duties as needed for operational needs.

This position is a Hybrid / Remote role requiring an employee to come in office 1 day per week.

Essential Duties:

• Reviews claims to ensure all key components were submitted accurately to the correct payer.

• Review Medi-Cal/Medicaid and CCS (California Children’s Services) claims.

• Reviews correspondence and denial information to determine why claims have not been paid and takes appropriate actions to ensure the accurate and timely submission of claims.

• Researches and analyzes accounts and payments to determine whether charges were billed properly, and to resolve incorrect information on patient accounts; reverses balance to credit or debit if charges were improperly billed.

• Corrects and resubmits claims and identifies issues that require attention. Makes all the appropriate corrections in the system and submits appeals as appropriate, following

individual payer guidelines and including all supporting documentation.

• Contacts insurance companies and or patient/guarantor to verify insurance eligibility and resolve payment problems; provides information to expedite collection process.

• Prepares adjustments for charges which cannot be billed and processes or submits to the supervisor per adjustment guidelines.

• Ensures authorization, TARs/SARs are included in claim submissions to payers and follows appropriate steps to secure the authorization/retro authorization. 

• At least 3 years of experience in medical billing, insurance collections, or medical accounts receivable within a healthcare setting.

• Hands-on knowledge of claim denial resolution, appeals processing, and insurance follow-up activities.

• Experience with hospital billing and payer requirements, including HMO, PPO, Medi-Cal/Medicaid and CCS (California Children’s Services) 

• Familiarity with eligibility verification, authorization review, and documentation standards tied to claim submission.

• Ability to review account activity, interpret reimbursement details, and correct billing errors with accuracy.

• Strong written and verbal communication skills for interacting with payers and collaborating within a high-performance team.

• Background supporting pediatric billing environments is preferred.

• Proven ability to manage a high-volume workload while maintaining quality and meeting productivity expectations.