Medical Collections Specialist

We are looking for a Medical Collections Specialist to support revenue cycle operations. This contract opportunity begins as leave coverage and offers the potential for long-term employment based on performance. The position is fully in office during the contract period and is well suited for someone who can manage a high-volume workload while resolving complex insurance and patient account issues with accuracy and professionalism.

Responsibilities:

• Review payer contracts and reimbursement terms to confirm expected payment amounts and identify discrepancies on outstanding claims.
• Interpret explanations of benefits and other payer responses to determine next steps for denied, delayed, or underpaid accounts.
• Investigate patient responsibility amounts by evaluating copays, deductibles, coinsurance, and out-of-pocket limits as they apply to each balance.
• Communicate with insurance carriers to pursue claim resolution, escalate payment issues, and secure accurate reimbursement.
• Prepare clear, persuasive written appeals to challenge denials and support timely reconsideration of claims.
• Speak with patients regarding account balances, explain adjudication results, and answer questions about remaining financial responsibility.
• Maintain consistent follow-up on assigned accounts while meeting productivity expectations and quality standards in a fast-paced environment.
• Partner with team members to prioritize workloads, solve account issues, and contribute to overall collection performance goals.
• Demonstrated experience in medical collections within a healthcare revenue cycle setting.
• Strong knowledge of medical terminology and its application to claim review and account follow-up.
• Ability to analyze payer contracts and determine correct allowed amounts and reimbursement expectations.
• Working knowledge of explanation of benefits documents and common denial scenarios.
• Understanding of insurance plan structures, including commercial coverage and Medicare Advantage products.
• Proven skill in appeal writing and resolving denied or underpaid healthcare claims.
• Confidence discussing balances with patients and explaining insurance payment outcomes in a clear and respectful manner.
• Ability to work efficiently under pressure, manage heavy account volume, and make sound decisions on claim resolution.