Account Resolution Specialist - Underpayment Appeals

Prime Healthcare; Lynwood, Northern (CA, KY); Hybrid; USD 32,000 - 39,000; Full time

Job summary

Prime Healthcare is seeking a Specialist, Account Resolution to lead timely follow-up of Managed Care/Commercial accounts. You will communicate with health plans by phone, maintain productivity standards, and ensure adherence to state collection guidelines as applicable.

The role requires four years of hospital managed care/ commercial collector experience, with a bachelor’s degree preferred. Knowledge of contract interpretation and familiarity with hospital billing are essential.

Qualifications

• Minimum of four years hospital managed care/commercial collector experience.
• Bachelor’s degree or equivalent work experience preferred.
• Knowledge of contract interpretation.
• Familiar with hospital billing requirements.

Responsibilities

• Lead timely follow-up of Managed Care/Commercial accounts.
• Communicate clearly and efficiently by phone with health plans.
• Maintain productivity standards and reports.
• Obtain State collection guidelines if applicable.
• Review managed care contracts.

Skills

Managed care experience

Contract interpretation

Hospital billing

Education

Bachelor's degree or equivalent

Job description

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

Responsibilities

The Specialist, Account Resolution is the lead responsible for the timely follow-up of Managed Care/Commercial accounts. Communicates clearly and efficiently by phone with health plans. Maintains productivity standards and reports. Responsible to obtain State collection guidelines if applicable. Reviews managed care contracts.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

• 1. Minimum of four years hospital managed care/commercial collector experience required.
• 2. Bachelor’s degree or equivalent work experience preferred
• 3. Knowledge of contract interpretation
• 4. Familiar with hospital billing requirements

Pay Transparency

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $23.00 to $28.00. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Privacy Notice

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf