Hoag Health System · 3 months ago
Collector II : Revenue Cycle Epic - Full Time - 08HR - Redhill Business Center
2975 Red Hill Ave, Costa Mesa, CA, 92626, US
Full-time
Onsite
Mid Level
$23.63/hr - $36.51/hrHoag Health System is a healthcare organization seeking a Collector II to manage payment resolutions with insurance companies and patients. The role involves evaluating claims, initiating appeals for underpayments, and ensuring proper billing practices within the Revenue Cycle processes.
Hospital & Health Care
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
Understanding of hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms
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
In addition to the above, the Collector II demonstrates proficiency in the functions mentioned above
Assists in multiples areas, payors or departments
Assist with special projects and/or additional tasks as needed
Able to problem solve issues as they arise and independently research as needed for resolution
Provides support and assists with training of peers as needed
Exceeds individual productivity and quality assurance standards for at least 6 consecutive months
No corrective action within the last 6 months
Qualification
Required
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
Understanding of hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms
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
In addition to the above, the Collector II demonstrates proficiency in the functions mentioned above
Assists in multiples areas, payors or departments
Assist with special projects and/or additional tasks as needed
Able to problem solve issues as they arise and independently research as needed for resolution
Provides support and assists with training of peers as needed
Exceeds individual productivity and quality assurance standards for at least 6 consecutive months
No corrective action within the last 6 months
Company
Hoag Health System
Hoag is a nonprofit, regional health care delivery system in Orange County, California.
Founded in 1952
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Robert Braithwaite
President and Chief Executive Officer
Eric Cheung
Chief Legal Officer, General Counsel, Senior Vice President
Recent News
PR Newswire
2025-07-14
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