Job Title: Collections Specialist
Department: Collections
Reports To: Associate Director of Revenue Cycle - Collections
FLSA Status: Non-Exempt
Position Summary:
As our Collections Specialist, you'll drive timely, accurate resolution of denied and underpaid insurance claims — filing, reviewing, and following each one through to payment. You'll dig into provider medical records, service claims, carrier explanations of benefits, denial letters, and electronic remits to work payments and denials promptly and submit appeals that hold up. You'll also play a key role in negotiations and Independent Dispute Resolution (IDR) filings for out-of-network claims.
Essential Duties and Responsibilities
- Monitor daily claims volume and filing deadlines, keeping collection efforts on track and ensuring the team follows standardized workflows and processes.
- Work payer denials, underpayments, and rejected claims quickly and thoroughly, turning them into paid claims.
- Investigate and correct claims that were paid or denied in error, resolving the root cause so it doesn't recur.
- Verify and reconcile every Explanation of Benefits (EOB) for accurate posting and processing and clear any issue holding up payment.
- Stay on top of incoming correspondence on open accounts — respond promptly, schedule negotiations, mediations, and arbitrations, and drive denied claims to an allowed amount or payment.
- Keep internal tracking logs current and accurate, confirming your collection work and follow-up stay on pace.
- Support payment posting so every account is accurately accounted for and every payment is processed and posted on time.
- Audit workflows and processes daily, weekly, and monthly to confirm collection tasks are on track, and flag training needs to the Associate Director of Revenue Cycle – Collections.
- Deliver weekly and monthly reports to leadership on trends, unposted payments, and training initiatives — insights that shape how the team improves.
- Keep every claim and account in compliance with healthcare state and federal regulations, privacy laws, and billing requirements.
- Take on other related duties as assigned.
