Senior Collections Representative Lead

UCSF Health; Emeryville (CA); On-site; USD 70,000 - 100,000; Full time

Job summary

UCSF Health in Emeryville is seeking a Sr. Collections Representative Lead who oversees billing and collections, trains staff, and handles complex government payer accounts. The role combines hands-on billing, backlog monitoring, and project work in a busy hospital setting.

You will work with EPIC, payer portals, and multiple systems to verify reimbursements, file denials, and ensure accurate CPT/ICD coding alignment. Strong analytical, communication, and compliance skills are essential.

Qualifications

• High school graduate or GED.
• Four or more years of experience in a hospital billing office environment.
• Knowledge of contracts, insurance billing requirements, UB04 claim forms, Medicare, Medi-Cal and compliance program regulations.
• Strong analytical and organizational skills and good interpersonal, verbal, and written communication.
• Computer skills including Microsoft Applications and E-mail; adequate keyboard skills.
• Proactive and assertive account resolution skills.
• Ability to balance assertiveness with compassion for patients.
• Understanding CPT, ICD, DRG, and HCPCS codes, and stop losses and per diems.
• Familiarity with billing systems and payer websites.

Responsibilities

• Reviewing, correcting, and completing billings to ensure complete and accurate billing for Medicare, Medi-Cal and Managed payer accounts.
• Calculate expected reimbursement and verify against actual payments received.
• File disputes with payers for denials and/or underpayments.
• Utilize EPIC and other databases to analyze information and take appropriate action on accounts.
• Monitor backlogs and assist with training and special projects.
• Collaborate with Patient Financial Services staff and management, as well as patients and vendors.

Skills

Analytical skills

Organizational skills

Interpersonal skills

Verbal communication

Written communication

Attention to detail

Education

High school diploma or GED

Tools

EPIC

Hospital Rates

CIRIUS

RevCyclePro

Imaging

DDE

Job description

Job Description

Sr. Collections Representative Lead Representative (Lead) . The Lead is assigned job functions that parallel that of a *Biller/Collector. The Lead has advanced knowledge of Government payer billing and collections and serves as a resource person to other staff members and management. The Lead is responsible for assisting with training, monitoring backlogs and are assigned special projects. The Lead is responsible for both billing and collections, gathering and securing all information needed for billing, follow up, and payment of accounts in accordance with the specific payer guidelines, policies, procedures, and compliance regulations. *A Biller/Collector is responsible for the following:

Reviewing, correcting, and completing billings to ensure complete and accurate billing of Medicare, Medi-Cal and/or Managed Medicare/Medi-Cal payers; calculates expected reimbursement to verify expected payments versus actual payments received; files disputes with payers for denials and/or underpayments; and is accountable and responsible for accurate billing and reconciles accounts to closure. The Lead utilize multiple databases and applications to analyze and take appropriate action on information or documents received. Applications and Databases consist of EPIC, Hospital Rates, CIRIUS, RevCyclePro, Imaging, DDE and various payer websites. Frequent contact with Patient Financial Services staff, departments and management, as well as patients, billing and professional fee and collection services vendors.

Qualifications

Requirements:

• High school graduates or GED certificate.
• Four or more years of experience in a hospital billing office environment.
• Knowledge of contracts, insurance billing requirements, UB04 claim forms, Medicare, Medi-Cal and compliance program regulations.
• Good analytical and organizational skills, interpersonal, verbal, and written communication skills.
• Knowledge of computer operation, keyboard functions, calculator, copier and fax machine operation.
• Adequate keyboard skills.
• Proactive and assertive account resolution skills.
• Must be a motivated individual with positive and exceptional work ethics.
• Ability to follow directions and written procedures.
• Ability to balance assertiveness with compassion for the patient and others.
• Must have a thorough understanding of CPT, ICD, DRG, and HCPC codes.
• Must have a thorough understanding of stop losses, per diems, carve-outs and other contract terms and conditions.
• Computer software skills (i.e. Microsoft Applications and E-mail, etc.)
• Must demonstrate an in-depth understanding of all aspects of billing greater than an Office Assistant III and Senior Collections Rep I. Note: This requirement applies only to UCSF Internals applicants only.

Preferred Qualifications

• Medical terminology experience.
• ICD, CPT4, HCPCS, DRG coding experience.
• Understanding of HIPAA rules and regulations.