Sr Managed Care Biller/Collector

Saint Mary's Health Network; Ontario (CA); On-site; USD 33,000 - 52,000; Full time

Job summary

Prime Healthcare in California is seeking a Senior Managed Care Biller/Collector to manage billing and collections for managed care, ensuring all payer requirements are met. You will gather needed information, follow up on denials, and package claims with attachments to secure timely payments.

Responsibilities include proactive payer follow up, resolving claim rejections, and billing accounts through closure, while adhering to regulations and internal policies.

Qualifications

• Minimum of three years hospital managed care/commercial collector experience.
• Two 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 deadlines.
• Working experience with all payer types including commercial, governmental, Medicare, Medicaid, HMO, etc.

Responsibilities

• Handle billing and collections for managed care accounts.
• Gather and secure information needed for billing and payment.
• Follow payer guidelines and compliance regulations.
• Resolve claim rejections and package claims with attachments.
• Proactive follow up with payers to secure payment.
• Bill accounts through closure.

Skills

Hospital billing

Managed care

Billing regulations

Payer knowledge

Out-of-state Medicaid

Education

Associate degree

Tools

Automated billing systems

Job description

Overview

Prime Healthcare is an award-winning health system headquartered in Ontario, California. Prime Healthcare operates 54 hospitals and has more than 360 outpatient locations in 15 states providing more than 3.0million patient visits annually. It is one of the nation’s leading health systems with over 60,000 employees and physicians. Twenty-one of the Prime Healthcare hospitals are members of the Prime Healthcare Foundation, a 501(c)(3) not-for-profit public charity. Prime Healthcare is actively seeking new members to join our corporate team!

Responsibilities

The Senior Managed Care Biller/Collector 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 for managed care. This includes maintaining the deficiency lists used to obtain missing documents from internal or external entities, resolving claim rejections, packaging claims, including global billing with attachments of professional fee claims, performing proactive follow up with payers and other entities and securing payment of accounts. The senior biller/collector is accountable and responsible for billing through account closure.

Qualifications

EDUCATION, EXPERIENCE, TRAINING

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

Pay Transparency

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options. A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $23.94 to $38.00. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Privacy Notice

Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf