Medical Collections Representative

We are seeking an experienced Medical Collections Representative with a strong background in hospital collections to join our team. This fully remote position is responsible for resolving outstanding hospital accounts receivable, following up with insurance payers, identifying denial trends, and ensuring timely reimbursement. The ideal candidate has experience working hospital accounts, understands the revenue cycle, and can independently manage a high-volume workload while maintaining accuracy and professionalism. The Medical Collection Representative will be an integral part of one of our prestigious health systems.

Key Responsibilities

• Manage and collect on outstanding hospital accounts receivable.
• Follow up with commercial, government, and managed care payers regarding claim status, denials, underpayments, and appeals.
• Research and resolve billing and reimbursement discrepancies.
• Review explanation of benefits (EOBs), remittance advice, and payer correspondence.
• Submit appeals, reconsiderations, and supporting documentation as needed.
• Document all collection activities accurately within the patient accounting system.
• Identify reimbursement trends and escalate payer issues appropriately.
• Work assigned accounts to meet productivity and collection goals.
• Collaborate with internal teams to resolve claim edits, denials, and payment delays.
• Maintain compliance with HIPAA and all applicable healthcare regulations.
• Minimum of 2 years of hospital collections experience required.
• Experience working hospital accounts receivable, including inpatient, outpatient, emergency department, or specialty services.
• Strong understanding of healthcare revenue cycle processes and insurance reimbursement methodologies.
• Experience with denial management, appeals, underpayments, and payer follow-up.
• Working knowledge of Medicare, Medicaid, and commercial insurance plans.
• Proficiency with electronic medical records (EMR), patient accounting systems, and clearinghouses.
• Strong analytical, problem-solving, and communication skills.
• Ability to work independently in a remote environment.