Senior Managed Care Billing & Collections Specialist

Saint Francis Health System; Ontario (CA); On-site; USD 33,000 - 52,000; Full time

Job summary

Prime Healthcare in Ontario, California is seeking a Senior Managed Care Biller/Collector responsible for both billing and collections for managed care accounts. You will gather required information, follow payer guidelines, resolve claim rejections, and ensure timely payment through proactive follow-up with payers and internal teams.

This role requires 3+ years in hospital managed care billing/collections, familiarity with Medicaid/Medicare rules, and experience with multiple payer types.

Qualifications

• Minimum of three years hospital managed care/commercial collector experience.
• 2 years of recent hospital managed care billing experience in an automated environment.
• Associates degree or equivalent work experience preferred.
• Knowledge of contract interpretation.
• Familiar with hospital billing requirements.
• Knowledge of out of state Medicaid billing guidelines.
• Knowledge of basic managed care, Medicaid/Medicare billing rules, regulations, and deadline.
• Working experience with all payer types including commercial, governmental, Medicare, Medicaid, HMO, etc. and the ability to cross-over into different payers.

Responsibilities

• The Senior Managed Care Biller/Collector is responsible for billing and collections, gathering and securing all information needed for billing, follow up, and payment of accounts in accordance with payer guidelines, policies, procedures, and compliance regulations for managed care.
• This includes maintaining deficiency lists used to obtain missing documents from internal or external entities and resolving claim rejections.
• Packaging claims, including global billing with attachments of professional fee claims, and performing proactive follow up with payers and other entities to secure payment of accounts.

Skills

Hospital billing experience

Payer knowledge (Medicare/Medicaid/HMO

Contract interpretation

Education

Associates degree or equivalent

Job description

Prime Healthcare in Ontario, California is seeking a Senior Managed Care Biller/Collector responsible for both billing and collections for managed care accounts. You will gather required information, follow payer guidelines, resolve claim rejections, and ensure timely payment through proactive follow-up with payers and internal teams.

This role requires 3+ years in hospital managed care billing/collections, familiarity with Medicaid/Medicare rules, and experience with multiple payer types.