Peregrine Team is seeking an experienced Collector III to join a leading healthcare organization. This role is responsible for resolving complex insurance and patient accounts, maximizing reimbursement, managing appeals, and serving as a resource to team members. The ideal candidate brings deep knowledge of hospital billing, managed care contracts, government payors, and revenue cycle operations.
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 and resolve complex insurance and patient accounts within assigned work queues.
- Analyze claims, payments, denials, and underpayments to ensure accurate reimbursement.
- Initiate and manage appeals while meeting all filing and timely appeal requirements.
- Interpret EOBs and ERAs to identify payment discrepancies and resolve outstanding balances.
- Research and resolve billing, coding, authorization, and reimbursement issues.
- Communicate effectively with insurance carriers, patients, and internal departments to facilitate account resolution.
- Document account activity, correspondence, and follow-up actions within patient accounting systems.
- Maintain a strong understanding of managed care contracts, reimbursement methodologies, and federal and state regulations.
- Serve as a resource for escalated account issues and complex reimbursement scenarios.
- Support onboarding and training of new team members.
- Identify opportunities for process improvement and recommend enhancements to workflows and procedures.
- Consistently meet or exceed productivity and quality standards.
- Participate in special projects and other duties as assigned.
Required Qualifications:
- High school diploma or equivalent.
- 5+ years of experience in hospital billing, healthcare collections, accounts receivable, or revenue cycle operations.
- Working knowledge of Epic Resolute, EpicCare, Epic CPOE, and reporting tools.
- Working knowledge of Microsoft Excel.
Preferred Qualifications:
- Strong knowledge of commercial, managed care, and government payors, including Medicare, Medi-Cal, and Tricare.
- Experience managing denials, appeals, underpayments, and complex account resolution.
- Understanding of hospital billing practices, including UB-04 and HCFA-1500 claim forms.
- Strong analytical, organizational, and problem-solving skills.
- Excellent communication and customer service abilities.
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