Primary Duties And Responsibilities • The Collector serves as the account representative for Hoag in working with insurance companies, government payors, and/or patients for resolution of payments and accounts resolution. • Completes assigned accounts within assigned work queues. • Obtains the maximum amount of reimbursement by evaluating claims at the contract rate with the use of the contract management tool for proper pricing (Examples: APC, DRG, APRDRG). • Reviews and initiates the initial appeal for underpayments observing all timely requirements to secure reimbursement due to Hoag. • Reviews and completes payor and/or patient correspondence in a timely manner. • Escalates to the payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments. • Reports new/unknown billing edits to direct supervisor for review and resolution. • Has a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations & admissions) through Patient Financial Services (billing & collections), including procedures and policies. • Has thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements. • Interprets Explanation of Benefits (EOBs) and Electronic Admittance Advices (ERAs) to ensure proper payment as well as assist and educate patients and colleagues with understanding of benefit plans. • Understanding of hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms. • Knowledge of HMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation, commercial and government payors (i.e. Medicare, Medi-Cal, TriCare, etc) and how these payors process claims. • Demonstrates knowledge of and effectively uses patient accounting systems. • Documents all calls and actions taken in the appropriate systems. • Accurately codes insurance plan codes. • Performs other duties as assigned. Education and Experience: • High school diploma or equivalent required. • One year of previous hospital business experience, or equivalent required or strong background in customer service. • Basic experience with insurance plans, hospital reimbursement methodology, and/or ICD10 and CPT coding. • Must have experience in Commercial Collections within a hospital setting. Must be able to interpret CMS-1500 and UB-04