Collector- CBO Full Time Day Shift

Pipeline Health•Cerritos, CA

About The Position

The Collector is responsible for collecting assigned accounts professionally and promptly, working with insurance companies and other payors to resolve accounts efficiently. The role reviews explanations of benefits (EOBs) for correct reimbursement, identifies and documents underpayments and overpayments, submits appeals for underpaid amounts, processes contractual adjustments, and documents overpaid accounts for final review by the Refund Analyst. The Collector also ensures financial classes, plans, and payor codes are correct and follows accounts through resolution and payment. The position requires working assigned queues and reports, handling an average of 35–45 accounts per day, and using financial, patient-account, and payer systems to review accounts, communicate with payors, rebill when needed, and pursue denials and underpayments. The Collector works with Hospital Contracts Management to resolve contract issues and ensures contract terms, discounts, Medi-Cal reimbursement rules, and applicable fee schedules are correctly applied. The role also handles correspondence, patient records, settlement options, and referrals to billers when secondary insurance applies. The Collector contributes to department operations and communications, works effectively with minimal supervision, maintains professional and courteous interactions, completes assigned training, keeps work areas and files orderly, and complies with HIPAA and Pipeline Health’s mission, vision, values, and AIDET patient communication standards. Other duties and special projects may be assigned.

Requirements

Knowledge of contracts.
Computer skills.
Ability to use IT systems accurately and proficiently.
Ability to understand Managed Care insurance billing, collections, and contracts.
Ability to communicate accurately and appropriately in writing and verbally.
Ability to listen, understand, problem-solve, and carry out duties to achieve optimal outcomes.
Ability to work efficiently under minimal supervision and adapt to changes in assignments and priorities.

Nice To Haves

Two to three years of current experience in an acute care hospital setting.

Responsibilities

Collect assigned accounts professionally and in a timely manner, following up after billing until payment is received.
Review EOBs for correct reimbursement and document underpayments and overpayments.
Appeal underpaid accounts and denials, and prepare contractual adjustments.
Document overpaid accounts in the system for the Refund Analyst’s final review.
Maintain contract reimbursement information and correct payor codes.
Ensure financial classes, plans, and plan IDs are updated to the appropriate payor.
Review aged accounts and document follow-up thoroughly and accurately.
Contact payors by phone or website and rebill accounts as needed.
Mail follow-up letters to patients or insurance companies when needed.
Arrange account settlement plans and present settlement options clearly and persuasively.
Work assigned queues and reports, averaging a minimum of 35–45 accounts per day.
Use financial and Paragon systems, One Content, payer portals and websites, and IPAS to review accounts.
Apply contractual adjustments and discounts as specified in each contract.
Refer accounts to a biller and forward the primary carrier’s EOB when secondary insurance applies.
Follow up on correspondence requiring action.
Retrieve patient records from the HBF system as needed.
Review Managed Care capped accounts before contractual write-off.
Work with Hospital Contracts Management to resolve contract issues and monitor contracts and EOBs for correct calculations and payment processing.
Review Managed Care Medi-Cal HMO EOBs according to Medi-Cal State HCPCS codes and fee schedule reimbursement.
Reclassify Managed Care accounts according to received EOBs.
Keep files, drawers, and cabinets free from unnecessary clutter.
Attend and complete assigned monthly training and comply with HIPAA regulations.
Communicate accurately and appropriately, collaborate with internal and external colleagues, and handle difficult situations discreetly and professionally.
Perform other duties and special projects as assigned.