Medi-Cal Collections Representative

Medi-Cal Collections Representative

Work Location: Los Angeles, CA, USA

Onsite or Remote

Flexible Hybrid

Work Schedule: Monday - Friday, 7:00 AM - 4:00 PM

Employment Type: 2 - Staff: Career

Duration: Indefinite

Primary Duties And Responsibilities

As a Medi-Cal Collections Representative, you will manage a designated portfolio of inpatient and outpatient claims, ensuring effective and efficient collection efforts. Your primary responsibilities include:

Conducting regular account reviews to identify outstanding balances.

Initiating and maintaining communication with third-party payers to resolve reimbursement discrepancies.

Diligently following up on claims to ensure timely resolution.

Communicate with insurance providers, patients, and internal departments to gather necessary information and resolve payment issues.

Salary Range: $26.79 - $38.05/hourly

Job Qualifications

We are seeking a self-directed, detail-oriented individual with:

High school diploma or GED; Minimum of 3 years of relevant experience, including at least 1 year in collections investigation

Experience in commercial and managed care collections, highly desired

Ability to interpret payer contracts and process contractual adjustments

In-depth knowledge of UB04 requirements and medical billing processes

Strong analytical skills and proven proficiency in Excel and spreadsheets

Understanding of collection techniques and laws, including AB1455, the Knox-Keene Act, Health & Safety Codes, etc.

Familiarity with medical terminology, CPT codes, HCPCS codes, health networks, IPAs, HMOs, PPOs, PCPs, and contract affiliations

Excellent verbal and written communication skills

Proficiency in Microsoft Office, especially Excel and Word

Exceptional organizational skills, with the ability to meet deadlines, work independently or as part of a team, and prioritize tasks effectively