Senior Managed Care Biller/Collector

Prime Healthcare•Ontario, CA

About The Position

The Senior Managed Care Biller/Collector is responsible for billing and collecting managed care accounts, gathering and securing all information needed for billing, follow-up, and payment according to payer guidelines, policies, procedures, and compliance regulations. The role includes maintaining deficiency lists to obtain missing documents from internal or external entities, resolving claim rejections, packaging claims—including global billing with professional fee claim attachments—and proactively following up with payers and other entities to secure payment. The Senior Managed Care Biller/Collector is accountable for accounts from billing through closure.

Requirements

At least three years of hospital managed care/commercial collector experience.
Two years of recent hospital managed care billing experience in an automated environment.
Knowledge of contract interpretation.
Familiarity with hospital billing requirements.
Knowledge of out-of-state Medicaid billing guidelines.
Knowledge of basic managed care and Medicaid/Medicare billing rules, regulations, and deadlines.
Work experience with commercial, governmental, Medicare, Medicaid, HMO, and other payer types, with the ability to transition between payer types.

Nice To Haves

Associate degree or equivalent work experience preferred.

Responsibilities

Gather and secure information required for billing, follow-up, and account payment in accordance with payer guidelines, policies, procedures, and compliance regulations.
Maintain deficiency lists and obtain missing documents from internal or external entities.
Resolve claim rejections.
Package claims, including global billing with attachments of professional fee claims.
Proactively follow up with payers and other entities to secure payment.
Manage accounts from billing through closure.