Collector III: Revenue Cycle Epic

Primary Duties and Responsibilities

• Completes assigned accounts within assigned work queues.
• Evaluates claims at the contract rate using the contract management tool for proper pricing (Examples: APC, DRG, APRDRG).
• Initiates the initial appeal for underpayments while observing all timely requirements to secure reimbursement due to Hoag.
• Reviews and completes payor and/or patient correspondence in a timely manner.
• Escalates accounts needing appeals due to improper billing, coding, and/or underpayments to the payor and/or patient.
• Reports new/unknown billing edits to direct supervisor for review and resolution.
• Has a strong understanding of Revenue Cycle processes, from Patient Access to Patient Financial Services, including procedures and policies.
• Understands managed care contracts, current payor rates, terms and conditions, and Federal and State requirements.
• Interprets Explanation of Benefits (EOBs) and Electronic Admittance Advices (ERAs) to ensure proper payment and assists patients and colleagues with understanding of benefit plans.
• Possesses knowledge of HMO, POS, PPO, EPO, IPA, Medicare Advantage, Covered California (Exchange), capitation, commercial, and government payors and how they process claims.
• Documents all calls and actions taken in the appropriate systems.
• Accurately codes insurance plan codes.
• Establishes a payment arrangement when patients are unable to pay in full at the time payment is due.
• May review for applicable cash rates, special rates, applicable professional and employee discounts.
• May process bankruptcy and deceased patient accounts.
• Performs other duties as assigned.
• Consistently meets individual productivity and quality assurance standards.
• Demonstrates proficiency in the functions of a Collector I & II.
• Strong knowledge of carrier’s (Federal/State/Private) regulations and guidelines.
• Assists peers and Supervisor/Manager with escalated situations.
• Participates in training and onboarding of new team members.
• Identifies ongoing training and recommendations for existing staff.
• Identifies and makes recommendations for development of processes or protocol changes.
• Exceeds individual productivity and quality assurance standards for at least 12 consecutive months.

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 than1,800 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 that is unsurpassed among Orange County’s health care providers. Since 1952, Hoag has served the local communities and continues its mission to provide the highest quality health care services through the 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 the areas of cancer, heart and vascular, neurosciences, women's health, orthopedics, and digestive health through our institutes. Hoag was the highest ranked hospital in Orange County in the 2024-2025 U.S. News &World Report, 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. To learn more about Hoag’s awards and accreditations, visit: https://www.hoag.org/about-hoag/awards-accreditations/.