Medical Collector

Pride Health is looking for a Medical Collector to support our client’s medical facility, which is Costa Mesa, CA . This is a great role with a 6 month contract with the possibility of extension and a great way to start working with a top-tier healthcare organization! It's an 100% onsite

Job Title: Medical Collector

Rate: $20 to 26/hr (Depends upon Years of experience)

Duration: 6-month contract

Location: Costa Mesa, CA

Position Summary:

The Medical Collector is responsible for managing accounts, collaborating with insurance companies, government payors, and/or patients to resolve payment discrepancies. The primary duties include ensuring claims are processed and paid according to contract rates, resolving underpayments, and initiating appeals as needed. This role requires a deep understanding of the Revenue Cycle, insurance claims, hospital billing procedures, and payor requirements.

Key Responsibilities:

• Serve as the primary account representative, managing communications with insurance companies, government payors, and patients to resolve accounts.
• Review and complete accounts within assigned work queues, ensuring timely resolution and maximum reimbursement.
• Use contract management tools to evaluate claims and verify proper pricing (e.g., APC, DRG, APRDRG).
• Initiate and manage appeals for underpaid claims, ensuring all timely requirements are met to secure reimbursement.
• Handle payer and patient correspondence promptly and professionally.
• Identify and escalate accounts requiring appeal due to billing, coding issues, or underpayment.
• Report new/unknown billing edits to the supervisor for review and resolution.
• Demonstrate strong knowledge of the Revenue Cycle, from Patient Access (authorizations and admissions) to Patient Financial Services (billing and collections).
• Possess a thorough understanding of managed care contracts, payor rates, and Federal and State requirements.
• Interpret Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to ensure accurate payment and assist patients and colleagues in understanding benefit plans.
• Understand hospital billing forms (UB04, HCFA 1500 forms).
• Be familiar with HMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), and government payors (e.g., Medicare, Medi-Cal, TriCare).
• Utilize patient accounting systems efficiently, ensuring all actions are documented accurately.
• Assist patients with establishing payment arrangements when needed and review for applicable discounts, rates, or payment plans.
• Manage bankruptcy and deceased patient accounts as necessary.
• Adhere to all internal policies and procedures related to billing and collections.
• Other duties as assigned.

Required Skills and Experience:

• One year of hospital business experience or equivalent in a related field, or strong background in customer service.
• Basic experience with insurance plans, hospital reimbursement methodology, and/or ICD-10 and CPT coding.
• Strong communication and customer service skills.
• Familiarity with healthcare reimbursement processes, hospital billing, and claims management.

Preferred Skills and Experience:

• Prior experience with EPIC is highly preferred.
• Familiarity with managed care contracts and insurance processing.
• Knowledge of medical codes (CPT, ICD-10), billing forms, and managed care agreements.

Education:

• High school diploma or equivalent required.

Benefits

Pride Global offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, auto, home insurance, pet insurance, and employee discounts with preferred vendors.

Equal Opportunity Employer

As a certified minority-owned business, Pride Global and its affiliates - including Russell Tobin, Pride Health, and Pride Now - are committed to creating a diverse environment and are proud to be an equal-opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.