Medicare Collections Representative

University of California • Los Angeles, CA

108d • $26 - $38

About The Position

As a Medicare Collections Representative, you will manage a designated portfolio of inpatient and outpatient claims, ensuring effective and efficient collection efforts. Your primary responsibilities include conducting regular account reviews to identify outstanding balances, initiating and maintaining communication with third-party payers to resolve reimbursement discrepancies, and diligently following up on claims to ensure timely resolution. You will also communicate with insurance providers, patients, and internal departments to gather necessary information and resolve payment issues.

Requirements

• High school diploma or GED.
• Minimum of 3 years of relevant experience, including at least 1 year in collections investigation.
• Experience in commercial and managed care collections, highly desired.
• Ability to interpret payer contracts and process contractual adjustments.
• In-depth knowledge of UB04 requirements and medical billing processes.
• Strong analytical skills and proven proficiency in Excel and spreadsheets.
• Understanding of collection techniques and laws, including AB1455, the Knox-Keene Act, Health & Safety Codes, etc.
• Familiarity with medical terminology, CPT codes, HCPCS codes, health networks, IPAs, HMOs, PPOs, PCPs, and contract affiliations.
• Excellent verbal and written communication skills.
• Proficiency in Microsoft Office, especially Excel and Word.
• Exceptional organizational skills, with the ability to meet deadlines, work independently or as part of a team, and prioritize tasks effectively.

Responsibilities

• Conduct regular account reviews to identify outstanding balances.
• Initiate and maintain communication with third-party payers to resolve reimbursement discrepancies.
• Diligently follow up on claims to ensure timely resolution.
• Communicate with insurance providers, patients, and internal departments to gather necessary information and resolve payment issues.

What This Job Offers

• Industry: Educational Services
• Education Level: High school or GED