Medicare Managed Care Medical Collections Specialist Job at Robert Half (Los Angeles)

Hospital Medical Collections Specialist

A respected hospital in the San Fernando Valley is seeking an experienced and re...

Location

United States , North Hollywood

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 2 years of hospital medical collections or healthcare revenue cycle experience required
Strong understanding of hospital billing, insurance follow-up, and denial management processes
Experience working with government and commercial payers, including Medicare and Medi-Cal managed care plans
Knowledge of inpatient and outpatient claim processing preferred
Excellent analytical, problem-solving, and communication skills
Ability to work independently in a fast-paced healthcare environment while managing multiple priorities
Proficiency in healthcare billing systems and Microsoft Office applications

Job Responsibility

Perform comprehensive follow-up on outstanding hospital accounts to secure accurate and timely reimbursement from insurance carriers and third-party payers
Review inpatient and outpatient claims to identify billing issues, denials, payment delays, and underpayments, and take proactive steps toward resolution
Manage collection efforts across multiple payer types, including Medicare Managed Care, Medi-Cal Managed Care, commercial insurance plans, HMOs, and PPOs
Prepare and submit appeals, reconsiderations, and supporting documentation for denied or improperly processed claims
Research and resolve account discrepancies by reviewing billing records, remittance advice, payer correspondence, and claim history
Collaborate with billing, coding, admissions, and clinical departments to correct claim issues and improve reimbursement outcomes
Maintain accurate and detailed documentation of collection activity, payer communications, and account status updates
Monitor assigned accounts to reduce aging AR and improve overall collection performance
Support departmental goals related to cash collections, denial management, and revenue cycle efficiency

What we offer

Medical insurance
Vision insurance
Dental insurance
Life insurance
Disability insurance
401(k) plan
Free online training

Fulltime

Hospital Medical Collections Specialist

A Hospital in the San Fernando Valley are looking for an experienced Hospital Me...

Location

United States , Van Nuys

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

At least 3 years of recent experience in hospital billing and medical collections
Hands-on knowledge of hospital revenue cycle processes, including claim follow-up, denial resolution, and appeals management
Experience working with multiple payer categories such as Medicare managed care, Medi-Cal managed care, and commercial insurance plans
Familiarity with HMO and PPO reimbursement structures in a hospital setting
Understanding of both inpatient and outpatient hospital accounts
Strong analytical skills with the ability to review account activity and identify barriers to payment
Effective communication and organizational skills to manage a high volume of accounts and payer interactions

Job Responsibility

Pursue payment on outstanding hospital accounts by conducting thorough follow-up with insurance carriers and other payers to secure accurate and timely reimbursement
Review inpatient and outpatient claims to identify billing issues, payment delays, denials, and underpayments, then take appropriate action to move accounts toward resolution
Manage collection activity across a range of payer types, including Medicare managed care, Medi-Cal managed care, commercial plans, and HMO or PPO coverage
Prepare and submit appeals, reconsiderations, and supporting documentation to challenge denied or incorrectly processed claims
Investigate account discrepancies by analyzing billing records, payer responses, and remittance details to determine the next steps for resolution
Coordinate with internal teams to correct claim information, resolve documentation gaps, and improve the collection of hospital receivables
Maintain detailed account notes and status updates to ensure clear documentation of collection efforts and payer communications

What we offer

Medical
Vision
Dental
Life and disability insurance
401(k) plan

Fulltime

Hospital Medical Collections Specialist

A respected hospital in the San Fernando Valley is seeking an experienced and re...

Location

United States , North Hollywood

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 2 years of hospital medical collections or healthcare revenue cycle experience required
Strong understanding of hospital billing, insurance follow-up, and denial management processes
Experience working with government and commercial payers, including Medicare and Medi-Cal managed care plans
Knowledge of inpatient and outpatient claim processing preferred
Excellent analytical, problem-solving, and communication skills
Ability to work independently in a fast-paced healthcare environment while managing multiple priorities
Proficiency in healthcare billing systems and Microsoft Office applications
All applicants applying for U.S. job openings must be legally authorized to work in the United States

Job Responsibility

Perform comprehensive follow-up on outstanding hospital accounts to secure accurate and timely reimbursement from insurance carriers and third-party payers
Review inpatient and outpatient claims to identify billing issues, denials, payment delays, and underpayments, and take proactive steps toward resolution
Manage collection efforts across multiple payer types, including Medicare Managed Care, Medi-Cal Managed Care, commercial insurance plans, HMOs, and PPOs
Prepare and submit appeals, reconsiderations, and supporting documentation for denied or improperly processed claims
Research and resolve account discrepancies by reviewing billing records, remittance advice, payer correspondence, and claim history
Collaborate with billing, coding, admissions, and clinical departments to correct claim issues and improve reimbursement outcomes
Maintain accurate and detailed documentation of collection activity, payer communications, and account status updates
Monitor assigned accounts to reduce aging AR and improve overall collection performance
Support departmental goals related to cash collections, denial management, and revenue cycle efficiency

What we offer

Medical, vision, dental, and life and disability insurance
401(k) plan

Fulltime

Hospital Medical Collections Specialist

A Hospital in the San Fernando Valley are looking for an experienced Hospital Me...

Location

United States of America , Van Nuys

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

At least 3 years of recent experience in hospital billing and medical collections
Hands-on knowledge of hospital revenue cycle processes, including claim follow-up, denial resolution, and appeals management
Experience working with multiple payer categories such as Medicare managed care, Medi-Cal managed care, and commercial insurance plans
Familiarity with HMO and PPO reimbursement structures in a hospital setting
Understanding of both inpatient and outpatient hospital accounts
Strong analytical skills with the ability to review account activity and identify barriers to payment
Effective communication and organizational skills to manage a high volume of accounts and payer interactions

Job Responsibility

Pursue payment on outstanding hospital accounts by conducting thorough follow-up with insurance carriers and other payers to secure accurate and timely reimbursement
Review inpatient and outpatient claims to identify billing issues, payment delays, denials, and underpayments, then take appropriate action to move accounts toward resolution
Manage collection activity across a range of payer types, including Medicare managed care, Medi-Cal managed care, commercial plans, and HMO or PPO coverage
Prepare and submit appeals, reconsiderations, and supporting documentation to challenge denied or incorrectly processed claims
Investigate account discrepancies by analyzing billing records, payer responses, and remittance details to determine the next steps for resolution
Coordinate with internal teams to correct claim information, resolve documentation gaps, and improve the collection of hospital receivables
Maintain detailed account notes and status updates to ensure clear documentation of collection efforts and payer communications

What we offer

Medical insurance
Vision insurance
Dental insurance
Life insurance
Disability insurance
401(k) plan
Free online training

Fulltime

Managed Care Billing Specialist

Location

United States , Los Angeles

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

At least 3 years of experience in medical insurance collections, insurance follow-up, or healthcare accounts receivable
Prior hospital-based billing or collections experience is required
Hands-on experience working with UB04 claims in a hospital environment
Strong understanding of payer guidelines, reimbursement practices, and insurance follow-up procedures
Background in denial resolution, appeals processing, and correction of claim-related issues
Ability to manage a high-volume workload with strong accuracy, organization, and attention to detail
Effective written and verbal communication skills with solid analytical and problem-solving ability
Familiarity with hospital billing systems and electronic medical records is preferred

Job Responsibility

Perform insurance collections follow-up on outstanding hospital claims with a focus on Medicare and Managed Care payers
Review and work hospital UB04 claims to ensure accurate billing and proper reimbursement
Investigate and resolve claim denials, rejections, underpayments, and payment delays
Submit corrected claims, supporting documentation, and appeals as needed to facilitate payment resolution
Follow up on aged accounts receivable and maintain productivity in line with departmental goals
Document all collection activity, account updates, and payer communications in the billing system
Collaborate with billing, coding, and patient financial services teams to resolve claim discrepancies and improve reimbursement outcomes
Monitor payer trends and escalate recurring issues impacting collections

What we offer

medical
vision
dental
life and disability insurance
company 401(k) plan

Fulltime

Medical Insurance Collections Specialist

Join a mission-driven healthcare team where your expertise directly impacts pati...

Location

United States , Van Nuys

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

At least 3 years of experience in hospital billing and collections within a healthcare or hospital environment
Working knowledge of medical billing, medical collections, denials management, and appeals processing
Hands-on experience with hospital revenue cycle operations for both inpatient and outpatient accounts
Familiarity with Medicare managed care, Medi-Cal managed care, commercial insurance, and HMO/PPO reimbursement structures
Ability to review account details, identify payment issues, and resolve balances through organized follow-up
Strong written and verbal communication skills for payer outreach, documentation, and appeal preparation
High attention to detail and the ability to manage multiple accounts while meeting productivity expectations

Job Responsibility

Drive resolution of outstanding hospital claims by reviewing account status, contacting payers, and securing timely reimbursement
Manage collection activity across a diverse portfolio of insurance plans, including Medicare Managed Care, Medi-Cal Managed Care, commercial payers, and HMO/PPO products
Research denied and underpaid claims, identify root causes, and prepare compelling appeals with supporting documentation
Handle both inpatient and outpatient hospital billing accounts while ensuring compliance with payer requirements and contractual guidelines
Analyze payment activity, billing edits, and account trends to identify reimbursement barriers and implement corrective actions
Maintain thorough and accurate documentation of payer communication, follow-up activity, and account resolution steps
Collaborate closely with billing, coding, and revenue cycle teams to resolve claim discrepancies and improve collection performance
Adapt to department workflows and support Collector I-level processes and training initiatives as needed

What we offer

medical, vision, dental, and life and disability insurance
enrollment in company 401(k) plan

Fulltime

Medical Billing Specialist

We are looking for a Medical Billing Specialist to support a Contract opportunit...

Location

United States , Aloha

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Previous experience in medical billing is required
Working knowledge of Medicare or Medicaid billing practices is strongly preferred
Experience handling insurance verification, medical claims, and claim follow-up is required
Familiarity with medical collections and payer communications is preferred
Proficiency with billing platforms such as Credible and Qualifacts is helpful
Ability to review detailed information carefully and maintain accuracy across multiple tasks
Strong interpersonal skills with a calm, respectful approach suited to a behavioral health or non-profit setting
Ability to manage responsibilities independently while supporting a collaborative team environment

Job Responsibility

Manage billing activities by preparing, reviewing, and submitting medical claims with a strong focus on accuracy and timeliness
Confirm insurance coverage and determine benefit eligibility before services are billed to help reduce denials and payment delays
Investigate unpaid or denied claims, communicate with payers as needed, and take corrective action to secure reimbursement
Coordinate authorization-related billing support for varying levels of care, including CareOregon-related processes when applicable
Maintain complete and organized billing records in designated systems such as Credible and Qualifacts
Assist with medical collections follow-up and other billing support duties based on team priorities and workload demands
Work collaboratively with internal staff to address claim issues while delivering attentive and empathetic communication
Monitor account status and identify discrepancies so billing concerns can be resolved efficiently
Contribute to daily revenue cycle activities in alignment with compliance standards and organizational procedures

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Integrated Care Manager - Medicare Advantage

Integrated Care Manager - Medicare Advantage (prior CM experience working in a h...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

2 year(s) of experience in full-time equivalent of direct clinical care to the consumer
Associate’s Degree in general field of study or Post High School Nursing Diploma or Master’s Degree in a behavioral health field of study (i.e., MSW, MA, MS, M.Ed.), Ph.D. or Psy.D
Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN
Within 4 years of hire as a Care Manager employee must hold a certification in case management from the following certifications
Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Case Management Administrator, Certified (CMAC), Case Management Certified (CMC), Certified Rehabilitation Counselor (CRC), Certified Registered Rehabilitation Counselor (CRRC), Certified Occupational Health Nurse (COHN), Registered Nurse Case Manager (RN, C), or Registered Nurse Case Manager (RN,BC)
Intermediate PC proficiency
Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones
Intermediate skill in word processing, spreadsheet, and database software
Maintain confidentiality and privacy
Advanced and current clinical knowledge

Job Responsibility

Assess and collect data related to the member from all care settings. Interview and collaborate with case-related providers, member and family to implement the care plan
Answer a diverse and high volume of health insurance related customer calls on a daily basis
Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc
Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests
Present status reports on all cases to the manager/supervisor and, when indicated, to the medical director
Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries
Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
Maintain all standards in consideration of state, federal, BCBSAZ, URAC, and other accreditation requirements
Maintain complete and accurate records per department policy
Demonstrate ability to apply plan policies and procedures effectively

Fulltime

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Medicare Managed Care Medical Collections Specialist

Job Description

Job Responsibility

Requirements

What we offer

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