Senior Collections Representative aka Follow up Representative
University of California, Emeryville, California, United States, 94608
Senior Collections Representative aka Follow up Representative
The Government, Commercial, Contract, and Managed Care (CCMC) unit within Medical Group Business Services (MGBS) is responsible for managing accounts receivable, billing, and follow-up with contracted payers. This includes navigating complex policy and compliance requirements to ensure adherence to payer contracts. The unit partners closely with UCSF Medical Center departments and billing agents to safeguard the quality and accuracy of the university's billing processes. The Senior Collections Representative
Team Lead provides oversight of billing and follow-up activities for accounts receivable across MGBS clients. This role requires strong technical knowledge of payer requirements and the ability to resolve outstanding insurance accounts through proactive communication with payers, MGBS units, UCSF clinical departments, and billing agents. As a team lead, the incumbent monitors staff production and quality, ensures adherence to the MGBS Situation Response Guide (SRG), manages escalation work queues (WQs), and serves as a resource for resolving complex issues. The Team Lead triages unresolved payer problems to the supervisor when appropriate, reports payer trends or delays when standard pathways cannot resolve issues, and may be required to distribute daily/weekly workloads to guide staff focus or support denial management projects in collaboration with the supervisor. The Lead function does not have staff reporting directly to him or her, but acts as a resource within the unit to maintain production oversight, timecard accuracy, and quality validation. In addition, the Team Lead supports staff development by providing training, coaching, and serving as a resource for escalated or complex issues. The role participates actively in unit and team meetings, contributes to process improvement initiatives, and ensures compliance with UCSF, MGBS, government, and HIPAA policies and procedures. Medical Group Business Services (MGBS) is responsible for the professional fee billing and collections for approximately 30 divisions in the School of Medicine. MGBS collects approximately $1B annually and takes ownership for continuing to find ways for the Divisions to ensure charges are captured and increase payments. Required Qualifications
High School Diploma or GED. Three or more years of insurance follow-up experience in healthcare revenue cycle (commercial payer focus preferred). Consistent record of professionalism, reliability, and excellent customer service. Proficiency in CPT, ICD-10, HCPCS, and modifiers. Demonstrated denials management and appeals experience. Strong communication skills (oral and written). Proficiency in Microsoft Outlook and Excel (basic functions). Ability to meet productivity/quality standards; effective time management and to coach/mentor staff and work collaboratively with peers and supervisors. The ability to work onsite in our Emeryville office. Preferred Qualifications
Associate's degree or higher education in Health Administration, Business, or related field. Prior working knowledge of Epic (Apex) Professional Billing (PB) system and work queues. Direct experience with surgical billing, commercial payer rules, and prior authorizations. Strong skills in advanced Excel reporting/analytics (pivot tables, payer trend tracking). Previous experience in a lead, trainer, or mentoring role within professional billing About UCSF
At UCSF Health, our mission of innovative patient care, advanced technology and pioneering research is redefining what's possible for the patients we serve
a promise we share with the professionals who make up our team. Consistently ranked among the top 10 hospitals nationwide by U.S. News & World Report
UCSF Health is committed to providing the most rewarding work experience while delivering the best care available anywhere. In an environment that allows for continuous learning and opportunities for professional growth, UCSF Health offers the ideal atmosphere in which to best use your skills and talents. Pride Values
UCSF is a diverse community made of people with many skills and talents. We seek candidates whose work experience or community service has prepared them to contribute to our commitment to professionalism, respect, integrity, diversity and excellence
also known as our PRIDE values. In addition to our PRIDE values, UCSF is committed to equity
both in how we deliver care as well as our workforce. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. Additional information about UCSF is available at diversity.ucsf.edu Join us to find a rewarding career contributing to improving healthcare worldwide. Equal Employment Opportunity
The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law.
The Government, Commercial, Contract, and Managed Care (CCMC) unit within Medical Group Business Services (MGBS) is responsible for managing accounts receivable, billing, and follow-up with contracted payers. This includes navigating complex policy and compliance requirements to ensure adherence to payer contracts. The unit partners closely with UCSF Medical Center departments and billing agents to safeguard the quality and accuracy of the university's billing processes. The Senior Collections Representative
Team Lead provides oversight of billing and follow-up activities for accounts receivable across MGBS clients. This role requires strong technical knowledge of payer requirements and the ability to resolve outstanding insurance accounts through proactive communication with payers, MGBS units, UCSF clinical departments, and billing agents. As a team lead, the incumbent monitors staff production and quality, ensures adherence to the MGBS Situation Response Guide (SRG), manages escalation work queues (WQs), and serves as a resource for resolving complex issues. The Team Lead triages unresolved payer problems to the supervisor when appropriate, reports payer trends or delays when standard pathways cannot resolve issues, and may be required to distribute daily/weekly workloads to guide staff focus or support denial management projects in collaboration with the supervisor. The Lead function does not have staff reporting directly to him or her, but acts as a resource within the unit to maintain production oversight, timecard accuracy, and quality validation. In addition, the Team Lead supports staff development by providing training, coaching, and serving as a resource for escalated or complex issues. The role participates actively in unit and team meetings, contributes to process improvement initiatives, and ensures compliance with UCSF, MGBS, government, and HIPAA policies and procedures. Medical Group Business Services (MGBS) is responsible for the professional fee billing and collections for approximately 30 divisions in the School of Medicine. MGBS collects approximately $1B annually and takes ownership for continuing to find ways for the Divisions to ensure charges are captured and increase payments. Required Qualifications
High School Diploma or GED. Three or more years of insurance follow-up experience in healthcare revenue cycle (commercial payer focus preferred). Consistent record of professionalism, reliability, and excellent customer service. Proficiency in CPT, ICD-10, HCPCS, and modifiers. Demonstrated denials management and appeals experience. Strong communication skills (oral and written). Proficiency in Microsoft Outlook and Excel (basic functions). Ability to meet productivity/quality standards; effective time management and to coach/mentor staff and work collaboratively with peers and supervisors. The ability to work onsite in our Emeryville office. Preferred Qualifications
Associate's degree or higher education in Health Administration, Business, or related field. Prior working knowledge of Epic (Apex) Professional Billing (PB) system and work queues. Direct experience with surgical billing, commercial payer rules, and prior authorizations. Strong skills in advanced Excel reporting/analytics (pivot tables, payer trend tracking). Previous experience in a lead, trainer, or mentoring role within professional billing About UCSF
At UCSF Health, our mission of innovative patient care, advanced technology and pioneering research is redefining what's possible for the patients we serve
a promise we share with the professionals who make up our team. Consistently ranked among the top 10 hospitals nationwide by U.S. News & World Report
UCSF Health is committed to providing the most rewarding work experience while delivering the best care available anywhere. In an environment that allows for continuous learning and opportunities for professional growth, UCSF Health offers the ideal atmosphere in which to best use your skills and talents. Pride Values
UCSF is a diverse community made of people with many skills and talents. We seek candidates whose work experience or community service has prepared them to contribute to our commitment to professionalism, respect, integrity, diversity and excellence
also known as our PRIDE values. In addition to our PRIDE values, UCSF is committed to equity
both in how we deliver care as well as our workforce. We are committed to building a broadly diverse community, nurturing a culture that is welcoming and supportive, and engaging diverse ideas for the provision of culturally competent education, discovery, and patient care. Additional information about UCSF is available at diversity.ucsf.edu Join us to find a rewarding career contributing to improving healthcare worldwide. Equal Employment Opportunity
The University of California is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, age, protected veteran status, or other protected status under state or federal law.