Revenue Cycle Specialist: Claims & Reimbursement

Hoag Health System; Costa Mesa (CA); On-site; USD 42,000 - 64,000; Full time

Job summary

Hoag Health System is seeking a patient-focused Collector to work with insurance companies, government payors, and patients to resolve payments and balance resolutions. You will manage designated queues, maximize reimbursements using contract rates, and handle underpayments through timely appeals.

The role requires knowledge of EOBs/ERAs, UB04 and HCFA-1500 forms, and familiarity with patient accounting systems.

Qualifications

• High school diploma or equivalent.
• 1 year hospital business experience or strong customer service background.
• Knowledge of insurance plans and hospital reimbursement methods.
• Proficient in understanding EOBs, ERAs, UB04 and HCFA 1500 forms.

Responsibilities

• Serve as the account representative for Hoag with insurance payors and/or patients for resolution of payments.
• Complete assigned accounts within established work queues.
• Obtain maximum reimbursement by evaluating claims at contract rates with contract management tools.
• Review and initiate initial appeals for underpayments and timely reimbursements.
• Document all calls and actions in the appropriate systems and establish payment arrangements when needed.

Skills

Accounts receivable

Medical billing

Patient billing

Education

High school diploma or equivalent

Tools

UB04 knowledge

HCFA 1500 forms

Contract management tools

Job description

Hoag Health System is seeking a patient-focused Collector to work with insurance companies, government payors, and patients to resolve payments and balance resolutions. You will manage designated queues, maximize reimbursements using contract rates, and handle underpayments through timely appeals.

The role requires knowledge of EOBs/ERAs, UB04 and HCFA-1500 forms, and familiarity with patient accounting systems.