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Collections Representative (L)

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

Job Description

Collections Representative 823823 (L)


  • Corrections of Accounts in Retro-Adjudication WQ and PB Charge Review WQ
  • Examines and evaluates accounts for appropriate registration and coverage.
  • Verification of erred RTE responses in PB Charge Review
  • Assign visits with the correct primary coverage and update unposted charges
  • Timely filing of PB Charge Review charge sessions in keeping with company lag day goals
  • Correction of registration errors made by frontend and backend staff
  • Clarification of primary coverage - working with the regulations of Medicare and Medi-Cal as well as contractual DOFR set-up
  • Review of entire AR of account to assure that all billing has been made to the correct payor in the correct order
  • Interpret account information and enter important details to provide an audit trail for follow up and patient
  • Research payments received in regards EOB (Explanation of Benefits), APEX and Health Logic to confirm correct primary payment. 
  • Review of non-payment and/or incorrect payment for possible registration and coverage. This may include, but is not limited to the use of the following reference tools and guidelines:
    • RTE response
    • Payor Website
    • EOB Information
    • APeX Follow-up Notes and SBO Notes
    • CMS Coverage Guidelines
    • Medi-Cal Eligibility Tool
    • Analyze Explanation of Benefits (EOBs) for accurate posting of rejection, adjustment and other posting requirements needed in APEX. 
  • Adheres to the rules and regulations of the different types of payers such as Medicare, Medi-Cal, CCS, PPO, EPO, HMO, Covered CA and commercial insurance. 
  • Perform Charge Corrections when cleaning-up charges billed in error. 
  • Balancing of payments of paid services not posted correctly
  • Retrieve all required information needed in order to evaluate correct credit balance and/or correct refund payee.
  • Effectively communicate with MGBS peers, payers, patients, company departments Leads, Assistant Managers and managers. 
  • Utilize knowledge of various systems including but not limited to: 
    • Microsoft Word, EXCEL, Outlook, APEX, Payor Web Portals, Health Logic, government and/or non-government websites, and any other information systems which would be required for insurance eligibility, benefit verification or other information needed during detailed follow-up. 
    • Other Retro-Adjudication Duties May include:
      • Secure guarantor/patient demographic and/or insurance information as required
      • Process correspondence as required in accordance with departmental procedures
      • Billing or rebilling corrected claims
      • Notify manager of possible procedural change for improving efficiency
  • Perform special projects or other duties as assigned by the manager
  • Attend monthly meetings and unit and team meetings aimed at increasing knowledge


  • At least 2 years of previous insurance billing experience
  • Demonstrate the ability to communicate effectively (orally and written)
  • Experience with MS Excel and Outlook
  • Ability to work independently or as needed with a team
  • Proven ability to coach and mentor staff for optimal results
  • Demonstrate the ability to perform all aspects of Retro Review with superior quality
  • Problem solving

$26 per hour               Emeryville, CA 94608              10 Month Assignment