Collector I: Patient Accounting

Hoag Health System; Costa Mesa (CA); On-site; USD 42,000 - 65,000; Full time

Job summary

Hoag Memorial Hospital Presbyterian is seeking a Collector to serve as the account representative with insurance companies, government payors, and patients to resolve payments and accounts. The role involves completing assigned accounts, maximizing reimbursement, and initiating timely appeals as needed.

You will work within the revenue cycle, from patient access through billing, and use contract management tools to ensure proper pricing and adjudication.

Qualifications

• High school diploma or equivalent required.
• Experience with hospital billing and reimbursement.
• Knowledge of ICD-10 and CPT coding.

Responsibilities

• Serve as the account representative for Hoag with insurance companies, government payors, and/or patients to resolve payments.
• Complete assigned accounts within defined work queues.
• Obtain maximum reimbursement by evaluating claims at contract rate using the contract management tool (e.g., APC, DRG, APRDRG).
• Review and initiate appeals for underpayments in a timely manner to secure reimbursement.
• Correspond with payors and patients promptly regarding billing.
• Escalate issues requiring appeals due to improper billing or underpayments.
• Document all calls and actions in the appropriate systems.

Skills

Revenue cycle knowledge

Insurance payors

EOBs/ERAs interpretation

UB04/HCFA forms knowledge

Customer service

Education

High school diploma or equivalent

Tools

Contract management tool

Patient accounting systems

Job description

Job Description

• The Collector serves as the account representative for Hoag in working with insurance companies, government payors, and/or patients for resolution of payments and accounts resolution.
• Completes assigned accounts within assigned work queues.
• Obtains the maximum amount of reimbursement by evaluating claims at the contract rate with the use of the contract management tool for proper pricing (Examples: APC, DRG, APRDRG).
• Reviews and initiates the initial appeal for underpayments observing all timely requirements to secure reimbursement due to Hoag.
• Reviews and completes payor and/or patient correspondence in a timely manner.
• Escalates to the payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments.
• Reports new/unknown billing edits to direct supervisor for review and resolution.
• Has a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations & admissions) through Patient Financial Services (billing & collections), including procedures and policies.
• Has thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements.
• Interprets Explanation of Benefits (EOBs) and Electronic Admittance Advices (ERAs) to ensure proper payment as well as assist and educate patients and colleagues with understanding of benefit plans.
• Understanding of hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.
• Knowledge of HMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation, commercial and government payors (i.e. Medicare, Medi-Cal, TriCare, etc) and how these payors process claims.
• Demonstrates knowledge of and effectively uses patient accounting systems.
• Documents all calls and actions taken in the appropriate systems.
• Accurately codes insurance plan codes.
• Performs other duties as assigned.

Primary Duties And Responsibilities

• The Collector serves as the account representative for Hoag in working with insurance companies, government payors, and/or patients for resolution of payments and accounts resolution.
• Completes assigned accounts within assigned work queues.
• Obtains the maximum amount of reimbursement by evaluating claims at the contract rate with the use of the contract management tool for proper pricing (Examples: APC, DRG, APRDRG).
• Reviews and initiates the initial appeal for underpayments observing all timely requirements to secure reimbursement due to Hoag.
• Reviews and completes payor and/or patient correspondence in a timely manner.
• Escalates to the payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments.
• Reports new/unknown billing edits to direct supervisor for review and resolution.
• Has a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations & admissions) through Patient Financial Services (billing & collections), including procedures and policies.
• Has thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements.
• Interprets Explanation of Benefits (EOBs) and Electronic Admittance Advices (ERAs) to ensure proper payment as well as assist and educate patients and colleagues with understanding of benefit plans.
• Understanding of hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.
• Knowledge of HMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation, commercial and government payors (i.e. Medicare, Medi-Cal, TriCare, etc) and how these payors process claims.
• Demonstrates knowledge of and effectively uses patient accounting systems.
• Documents all calls and actions taken in the appropriate systems.
• Accurately codes insurance plan codes.
• Performs other duties as assigned.

Qualifications

Education and Experience

• High school diploma or equivalent required.
• One year of previous hospital business experience, or equivalent required or strong background in customer service.
• Basic experienece with insurance plans, hospital reimbursement methodology, and/or ICD10 and CPT coding.

About Us

Hoag Memorial Hospital Presbyterian is a nonprofit regional health care delivery network in Orange County, California, consisting of three acute-care hospitals with sixteen urgent care centers, eleven health centers and a network of more than1,800 physicians, 100 allied health members, 8,000 employees, and 2,000 volunteers. More than 30,000 inpatients and 550,000 outpatients choose Hoag each year.

For over 70 years, Hoag has delivered a level of personalized care that is unsurpassed among Orange County’s health care providers. Since 1952, Hoag has served the local communities and continues its mission to provide the highest quality health care services through the core strategies of quality and service, people, physician partnerships, strategic growth, financial stewardship, community benefit and philanthropy.

Hoag offers a comprehensive blend of health care services including six institutes providing specialized care in the areas of cancer, heart and vascular, neurosciences, women's health, orthopedics, and digestive health through our institutes.

Hoag was the highest ranked hospital in Orange County in the 2024-2025 U.S. News &World Report, the only Orange County hospital ranked in the top 10 for California. The organization was ranked the #5 hospital in the Los Angeles Metro Area and the #10 hospital in California.

To learn more about Hoag’s awards and accreditations, visit: https://www.hoag.org/about-hoag/awards-accreditations/ .

Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind.

Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment.

Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.