Collector III

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.

Originally posted on Himalayas