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Collections Representative

Finance | Emeryville, CA | Full Time, Contract, and Temporary

Job Description

Collections Representative 770342 

Senior Collection Representative is responsible for collections and resolution of all outpatient accounts with commercial insurance balances across various work queues. The Senior Collection Representatives conduct proactive follow up with payors regarding nonpayment, underpayments or incorrect payments in a stratified manner, calculates expected reimbursement and recommends accounts for collection agencies or legal assignment when needed. The Senior Collection Representatives negotiate prompt payment/in lieu of audit discounts as delineated in the departmental guidelines. The Senior Collection Representatives reconcile the accounts to closure and work only outpatient accounts.


  • Analyze and interpret the various managed care contracts via Contract Matrix Grid to ensure compliance with the terms and conditions when calculating expected reimbursement.    
  • Performs expected reimbursement override and updates accordingly for primary and secondary insurance when needed.
  • Ensure correct payer/plan codes are utilized in accordance with managed care contracts and notify management of needed changes.
  • Ensure appropriate authorizations, pre-certifications are on file and appropriately documented on the UB04 and/or on-line systems as required.
  • Thorough understanding of all UB04 fields including specific requirements of payers.
  • Monitors current status of billing and collections in a stratified manner via RFI work queues by directing appropriate questions to responsible departments or agencies
  • Secure all forms and pertinent information necessary for filing appeals (i.e., medical records reports, denials, EOBs, R/A’s, COB information, departmental reports, authorizations, pre-certifications, as required).
  • Enter detailed account notes in EMR system on initial follow up with confirmation of expected reimbursement, confirming receipt of the claim by payer either via EDI or hard copy, and documenting payer contact and details via telephone or payer website.
  • Conducts proactive follow up with payers regarding non-payments, underpayments, or incorrect payments in a stratified and timely manner. Files appeals meeting payer format and timely appeal requirements.
  • Processes all-payer denials, inquiries, and correspondence in a timely and stratified manner utilizing all work queues as assigned.
  • Utilizes APEX Smart Text Letter for recording and filing all Provider Disputes for appeal.
  • Performs and completes undo billing procedure when new insurance is added or updated based on payer information and financial class assigned.
  • Maintains current status of accounts by processing late charges, credits, corrected billings, contractual adjustments or escalates to management for administrative write-offs.
  • Utilizes account note types and activity codes in a stratified manner to ensure accurately and timely follow up is completed.
  • Manages clinical denials and utilizes the Case Management system to route and report denial information to ensure appeals are received timely for follow up.
  • Utilizes external database and applications when needed to accurately research information in the collection process (Revenue Cycle Pro, Green Sheet, and Transplant Database)
  • Maintains all logins and passwords for payer websites utilized while performing collection follow up and ensuring logins and passwords are secure at all times.
  • Meets daily and weekly productivity standards to ensure timely and accurate follow up of accounts receivable helping to minimize aged accounts receivable. 


  • High school diploma or equivalent
  • Previous collection experience in a hospital environment or healthcare setting
  • Excellent analytical, organizational, interpersonal skills along with verbal and written skills
  • Knowledge of computer operations, dual monitors, and required knowledge on how to use Microsoft applications (MS Word, MS Office, MS Excel) including PDF documents
  • Superior keyboarding skills (ability to type >40 words per minute)
  • Motivated individual with a positive attitude and strong work ethics

Preferred Qualifications:

  • Two or more years of experience in a hospital or physician’s office with collection experience
  • Experience with EPIC hospital or professional billing systems or similar EMR
  • Excellent analytical, organizational, interpersonal skills along with verbal and written skills
  • Knowledge of commercial insurance contracts and reimbursement rates (Aetna, Anthem Blue Cross, Blue Shield, Capitation, Cigna, Health Net, United Healthcare, Workers Compensation, etc)
  • Knowledge of electronic billing systems including funds transfers (EFT), remittance advice, (ERA) and online payer websites for electronic messaging, etc.
  • Understanding of HIPAA rules and regulations

 $28 per Hour       Emeryville, CA 94608       5 Month Assignment