Collections Representative - Government Billing

Software Guidance & Assistance, Inc., (SGA), is searching for a Collections Representative - Government Billing for a Contract assignment with one of our premier Healthcare clients in Los Angeles, CA.

Responsibilities :
The Collections Representative - Government Billing is responsible for the accurate and timely billing of inpatient, outpatient, and laboratory claims to government and third-party payers. This role ensures compliance with payer regulations, billing guidelines, and timely filing requirements while maintaining account accuracy and maximizing reimbursement.

• Claims Billing & Processing
• Review and analyze accounts to determine appropriate billing procedures based on payer type, financial class, and claim requirements.
• Prepare, review, and submit electronic and paper claims in accordance with federal, state, payer, and organizational guidelines.
• Verify claim accuracy, including demographics, charges, authorizations, coding, and supporting documentation.
• Research and obtain missing information from internal departments and external sources as needed.
• Monitor and resolve claim edits, rejections, denials, and billing exceptions.
• Submit required supporting documentation, including authorizations, medical records, consent forms, and payer-specific forms.
• Ensure compliance with timely filing requirements and payer regulations.
• Identify and bill capitated services to the appropriate responsible party.
• Maintain claim management systems and resolve claim scrubber edits and billing holds.
• Account Maintenance & Adjustments
• Process account corrections, adjustments, transfers, rebills, and write-offs according to departmental procedures.
• Update payer, case, and account information accurately and document all actions taken.
• Submit adjustment requests requiring management approval when applicable.
• Maintain accurate account notes and billing documentation within patient accounting systems.
• Documentation & Compliance
• Document billing activity, claim details, expected reimbursement, payments, and account actions clearly and accurately.
• Protect patient confidentiality and comply with HIPAA and organizational privacy standards.
• Adhere to all regulatory requirements, hospital policies, and billing compliance guidelines.
• Quality & Performance
• Maintain established productivity and quality standards.
• Monitor accounts to ensure timely claim submission and follow-up.
• Communicate billing issues, trends, and operational concerns to leadership.
• Participate in performance improvement initiatives and process enhancement efforts.
• Support special projects and departmental objectives as assigned.
• Customer Service
• Provide professional and courteous service to patients, payers, and internal stakeholders.
• Demonstrate effective communication and problem-solving skills.
• Foster positive working relationships across departments and with external partners.

Required Skills :

• High school diploma or equivalent required.
• 2-5 years of experience in Medicare Billing and collection for inpatient and outpatient
• Proficiency with standard office equipment and computer applications.
• Knowledge of hospital billing practices, government payer regulations, and managed care contracts.
• Experience with electronic claims processing and patient accounting systems.
• Proficiency in Microsoft Office applications, including Word and Excel.
• Strong analytical, organizational, and problem-solving skills.
• Ability to manage multiple priorities and meet productivity and quality expectations.
• Knowledge of healthcare billing software and payer portals preferred.

SGA is a technology and resource solutions provider driven to stand out. We are a women-owned business. Our mission: to solve big IT problems with a more personal, boutique approach. Each year, we match consultants like you to more than 1,000 engagements. When we say let's work better together, we mean it. You'll join a diverse team built on these core values: customer service, employee development, and quality and integrity in everything we do. Be yourself, love what you do and find your passion at work. Please find us at .

SGA is an Equal Opportunity Employer and does not discriminate on the basis of Race, Color, Sex, Sexual Orientation, Gender Identity, Religion, National Origin, Disability, Veteran Status, Age, Marital Status, Pregnancy, Genetic Information, or Other Legally Protected Status. We are committed to providing access, equal opportunity, and reasonable accommodation for individuals with disabilities in employment, and our services, programs, and activities. Please visit our company to request an accommodation or assistance regarding our policy.