Peregrine Team is seeking an experienced Collector II to join a leading healthcare organization. This role is responsible for managing insurance and patient accounts, resolving outstanding balances, maximizing reimbursement, and ensuring accurate account resolution. The ideal candidate has a strong understanding of hospital revenue cycle operations, insurance billing, and collections.
Location: Open to local candidates in Costa Mesa, CA (on-site) or remote candidates residing in Georgia, Iowa, Indiana, Missouri, Nebraska, North Carolina, Tennessee, Texas, Utah, Wisconsin, or Wyoming.
Key Responsibilities:
- Manage assigned insurance and patient accounts within designated work queues.
- Follow up with commercial, government, and managed care payors to resolve outstanding claims and secure reimbursement.
- Review claims and payment activity to identify underpayments, denials, and reimbursement discrepancies.
- Initiate and manage appeals while meeting all filing and timely appeal requirements.
- Interpret Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to ensure accurate payment posting and account resolution.
- Research and resolve billing, coding, authorization, and payment issues.
- Communicate with insurance companies, patients, and internal departments to facilitate account resolution.
- Document all account activity, correspondence, and follow-up actions accurately within patient accounting systems.
- Establish payment arrangements with patients when appropriate.
- Maintain knowledge of managed care contracts, reimbursement methodologies, and government payor regulations.
- Assist with special projects, process improvements, and department initiatives as needed.
- Support team members through knowledge sharing, training, and problem-solving assistance.
- Consistently meet or exceed productivity and quality standards.
Required Qualifications:
- High school diploma or equivalent.
- Minimum 3 years of experience in hospital billing, healthcare collections, revenue cycle, medical accounts receivable, or a related healthcare financial services role.
- Experience with Epic Resolute, EpicCare, and Epic CPOE.
- Intermediate Microsoft Excel skills.
Preferred Qualifications:
- Strong understanding of insurance billing, collections, and reimbursement processes.
- Experience working with commercial, managed care, and government payors, including Medicare and Medi-Cal.
- Ability to interpret EOBs, ERAs, and insurance payment activity.
- Intermediate Microsoft Excel skills.
- Strong analytical, organizational, and problem-solving abilities.
- Excellent communication and customer service skills.
- Knowledge of UB-04 and HCFA-1500 claim forms.
- Understanding of HMO, PPO, POS, EPO, IPA, Medicare Advantage, Covered California, and capitated payment models.
- Experience handling denials, appeals, underpayments, and complex account resolution.
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