Irvine, CA

July 2, 2020

Location: Irvine, CA

Department: Billing and Collections

Reports To:  Reimbursement Manager

FLSA Status: Non-Exempt




The Medical Collector/Patient Advocate Representative follows-up on the status of submitted claims and invoices; requests medical records as needed; prepares various medical appeals and the submissions of such appeals to insurance carriers; follows-up on all submitted medical appeals in a timely manner.



  • Collects money due from insurance companies, hospital and patients in compliance with CLIA, OIG and all other applicable legal requirements.
  • Contacts insurance companies to follow up on claims and appeals which have been submitted, but no payment or correspondence received within the allotted time frame.
  • Processes and follows up with patients for copays and deductible amounts due.
  • Contacts clients to obtain medical records as needed for submission of a medical appeal or payer’s review of a claim.
  • Prepares custom appeal letters and letters of interest to various insurance carriers and managed care groups.
  • Reviews files to determine if amounts should be written off based on acceptable reimbursement, then forwards these to the Reimbursement Director.
  • Investigates and prepares any necessary refund requests from payors for submission to the Reimbursement Director.
  • Negotiates reimbursement single settlements with various insurance carriers and third party administrators, based upon department guidelines.
  • Interfaces with insurance company representatives, doctor’s offices and hospitals regarding schedule of services and billing inquiries.
  • Assists department director in the development of new procedures and systems to enhance productivity.
  • Provides account information to the sales force as needed.

The above listing represents the general duties considered essential functions of the job and is not to be considered a detailed description of all the work requirements that may be inherent in the position.



  • This position may interact with all departments within the organization, especially Customer Care and external vendors.



  • High school diploma or general education degree
  • Associate’s degree preferred
  • 3+ years related experience
  • This position requires no supervisory responsibilities.



To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to individuals with disabilities to perform the essential functions.

  • Advanced technical knowledge of Microsoft products required (Excel, Word, Outlook)
  • Must be able to work in a fast-paced environment
  • Must have strong organizational skills and attention to detail
  • High degree of accuracy
  • Manage multiple tasks independently
  • Other skills necessary are accounting, data entry, general math, analytical, thoroughness, research, verbal/written communication
  • Excellent problem resolution
  • Excellent customer service skills
  • Outside-the-box thinker



  • General office environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
  • Maintains a clean, neat, and orderly work area.
  • Adheres to Department Specific Safety Guidelines.



  • Standing, sitting, walking, bending, reaching, manual manipulation, and lifting up to 15 pounds.