Sr Managed Care Biller/Collector

St. Joseph Medical Center; Ontario (CA); On-site; USD 33,000 - 52,000; Full time

Job summary

Prime Healthcare in California seeks a Senior Managed Care Biller/Collector to handle billing and collections across multiple payers. You will gather required documents, follow payer guidelines, and work to resolve claim rejections while ensuring timely payment for hospital accounts.

The role requires several years of hospital managed care experience, familiarity with Medicaid/Medi-Cal and commercial payer rules, and the ability to work in a fast-paced, automated environment.

Qualifications

• Associates degree or equivalent work experience preferred.
• Knowledge of contract interpretation and hospital billing requirements.
• Familiar with out-of-state Medicaid billing guidelines and basic managed care rules (Medicare/Medicaid).
• Experience with all payer types including commercial, governmental, and HMO cross-over.

Responsibilities

• Billing and collections for managed care, gathering information for billing, follow-up, and payment per payer guidelines.
• Resolve claim rejections, package claims with attachments, and ensure payment through account closure.

Education

Associates degree or equivalent

Contract interpretation

Hospital billing requirements

Out of state Medicaid billing guidelines

Managed care, Medicare/Medicaid billing rules

All payer types experience

Three years hospital managed care/collector experience

Two years hospital managed care billing in automated environment

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