Collector I : Patient Accounting

About the role

The Collector serves as the account representative for Hoag, working with insurance companies, government payors, and/or patients to resolve payments and accounts.

Responsibilities

• Completes assigned accounts within assigned work queues.
• Obtains the maximum amount of reimbursement by evaluating claims at the contract rate using the contract management tool for proper pricing (e.g., 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 accounts to payors and/or patients that need to be appealed due to improper billing, coding, or underpayments.
• Reports new/unknown billing edits to direct supervisor for review and resolution.
• Demonstrates a strong understanding of Revenue Cycle processes, from Patient Access (authorizations & admissions) through Patient Financial Services (billing & collections), including procedures and policies.
• Applies thorough knowledge of managed care contracts, current payor rates, terms and conditions, as well as Federal and State requirements.
• Interprets Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to ensure proper payment and assist patients and colleagues in understanding benefit plans.
• Understands hospital billing form requirements (UB04) and is familiar with HCFA 1500 forms.
• Knowledgeable about HMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation, commercial, and government payors (e.g., Medicare, Medi-Cal, TriCare) 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.
• Establishes payment arrangements when patients are unable to pay in full at the time payment is due.
• Reviews applicable cash rates, special rates, professional, and employee discounts.
• Processes bankruptcy and deceased patient accounts.
• Consistently meets individual productivity and quality assurance standards.
• Performs other duties as assigned.

Requirements

• High school diploma or equivalent required.
• One year of previous hospital business experience, or equivalent, or a strong background in customer service.
• Basic experience with insurance plans, hospital reimbursement methodology, and/or ICD10 and CPT coding.

About Us

Hoag Memorial Hospital Presbyterian is a nonprofit regional health care delivery network in Orange County, California, consisting of three acute-care hospitals with sixteen urgent care centers, eleven health centers, and a network of more than 1,800 physicians, 100 allied health members, 8,000 employees, and 2,000 volunteers. More than 30,000 inpatients and 550,000 outpatients choose Hoag each year.

For over 70 years, Hoag has delivered a level of personalized care unsurpassed among Orange County’s health care providers. Since 1952, Hoag has served local communities and continues its mission to provide the highest quality health care services through core strategies of quality and service, people, physician partnerships, strategic growth, financial stewardship, community benefit, and philanthropy.

Hoag offers a comprehensive blend of health care services, including six institutes providing specialized care in cancer, heart and vascular, neurosciences, women's health, orthopedics, and digestive health. Hoag was the highest-ranked hospital in Orange County in the 2024-2025 U.S. News & World Report and the only Orange County hospital ranked in the top 10 for California. The organization was ranked the #5 hospital in the Los Angeles Metro Area and the #10 hospital in California.