Collections Specialist

Job Overview

The Collections Specialist will be responsible for overseeing outstanding medical receivables and insurance payments, ensuring payments are collected timely while maintaining compliance with healthcare regulations and patient confidentiality. The role requires strong communication and problem-solving skills with familiarity in medical billing systems and insurance claims procedures.

Key Qualifications

• Completion of high school diploma or GED is essential; an Associate degree in Accounting, Business, or Healthcare Administration is preferred.
• At least 1 to 2 years of relevant experience in medical collections, healthcare billing, or related roles within hospital or clinic environments.
• Proficiency or familiarity with Electronic Health Records (EHR) and billing platforms such as Epic, Cerner, or Meditech is desirable.
• Solid understanding of insurance claim processing, CPT/ICD-10 coding essentials, and third-party payer protocols.
• Excellent abilities in communication, negotiation, and resolving problems efficiently.
• Capability to handle multiple accounts simultaneously and prioritize duties in a dynamic, fast-paced setting.

Primary Responsibilities

• Manage and monitor aged accounts receivable for both patient and insurance balances.
• Communicate with patients, insurance carriers, and third-party payers through phone, email, or written correspondence to recover overdue funds.
• Investigate and resolve claim denials or underpayments, including the preparation and submission of appeals when required.
• Collaborate closely with the billing team to ensure accurate claim filings and resolve any discrepancies.
• Inform patients regarding their outstanding balances, insurance coverages, and options for payment arrangements.
• Meticulously document all collection efforts and patient communications within the hospital's EHR or billing system.
• Achieve or surpass the set departmental goals for productivity and collection targets.
• Continuously update knowledge on payer directives, insurance rules, and relevant federal and state laws such as HIPAA and FDCPA.
• Uphold patient confidentiality rigorously and maintain professional respect in all interactions.
• Follow up on accounts with outstanding balances that lack established payment plans.

Physical Requirements

• Extended sitting periods with intensive computer work are expected.
• Occasional lifting of office supplies or files weighing up to 15 pounds may be necessary.