Senior Commercial Hospital Collections Representative
About The Position
As a Senior Collections Representative, you will oversee a designated portfolio of inpatient and outpatient claims to maximize collection outcomes. In this role, you will conduct thorough and strategic account reviews, lead efforts to resolve reimbursement discrepancies with third-party payers, and implement proactive follow-up strategies to accelerate account resolution. This position requires strong communication skills to work effectively with insurance providers, patients, and internal departments while gathering essential information and addressing payment challenges promptly. You will play a key role in optimizing account management efficiency and ensuring timely resolution within the revenue cycle process.
Requirements
- High school diploma or General Education Diploma (GED) (Required)
- 5+ years of progressive experience in collections, including substantial experience in complex collections investigations and resolution (Required)
- Comprehensive understanding of UB04 requirements and advanced knowledge of medical billing processes, including familiarity with Medicare and Medicaid regulations
- Advanced proficiency in analytical tools and software, with demonstrated expertise in Excel/spreadsheets for data analysis and reporting
- In-depth knowledge of collection techniques, laws, and regulations, including AB1455, the Knox-Keene Act, Health & Safety Codes, and other applicable statutes
- Extensive familiarity with medical terminology, CPT and HCPCS codes, and healthcare networks including IPAs, HMOs, PPOs, PCPs, as well as contract affiliations and provider networks
- Exceptional verbal and written communication skills, including the ability to convey complex information clearly and concisely
- Advanced proficiency in Microsoft Office applications, particularly Excel for complex data analysis and Word for documentation and reporting
- Proven ability to manage multiple priorities, meet deadlines consistently, and work both independently and collaboratively within a team environment
- Ability to interpret and apply payer contracts, negotiate payment terms, and process contractual adjustments effectively
Responsibilities
- oversee a designated portfolio of inpatient and outpatient claims to maximize collection outcomes
- conduct thorough and strategic account reviews
- lead efforts to resolve reimbursement discrepancies with third-party payers
- implement proactive follow-up strategies to accelerate account resolution
- work effectively with insurance providers, patients, and internal departments while gathering essential information and addressing payment challenges promptly
- play a key role in optimizing account management efficiency and ensuring timely resolution within the revenue cycle process
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Industry
Educational Services
Education Level
High school or GED
Number of Employees
5,001-10,000 employees
