Revenue Cycle Collector: Claims & Reimbursement Specialist

Tek Ninjas; Costa Mesa (CA); On-site; USD 42,000 - 62,000; Full time

Job summary

Tek Ninjas in Costa Mesa, CA is seeking a Billing Collector to serve as the primary liaison with insurers, government payors, and patients to resolve payments and outstanding balances. The role focuses on maximizing reimbursement by evaluating claims, initiating timely appeals for underpayments, and maintaining accurate documentation across patient accounts systems.

Strong knowledge of billing rules and patient communication is essential.

Qualifications

• Understanding of Revenue Cycle processes and workflows.
• Experience reviewing EOBs/ERAs and hospital claim adjudication.
• Ability to evaluate claims for pricing and reimbursement.
• Capable of explaining benefit plans to patients.

Responsibilities

• The Collector serves as the account representative for the client 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 client.
• 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 Advice (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 account systems.
• Documents all calls and actions taken in the appropriate systems.
• Accurately codes insurance plan codes.
• Establishes a payment arrangement when patients are unable to pay in full at the time payment is due.
• May review applicable cash rates, special rates, applicable professional and employee discounts.
• May process bankruptcy and deceased patient accounts.

Skills

Revenue Cycle

Billing & Coding

EOBs & ERAs

Patient communications

Job description

Tek Ninjas in Costa Mesa, CA is seeking a Billing Collector to serve as the primary liaison with insurers, government payors, and patients to resolve payments and outstanding balances. The role focuses on maximizing reimbursement by evaluating claims, initiating timely appeals for underpayments, and maintaining accurate documentation across patient accounts systems.

Strong knowledge of billing rules and patient communication is essential.