Medical Billing and Collections Specialist

Location 822 W 4TH ST,Leadville, CO, 80461-3861,United States Base Pay $18.75 - $26.48 / Hour Job Category Business office Employee Type FT Non-Exempt Contact information Phone View phone number on click.appcast.io Description Medical Billing and Collection Specialist- Full-time, day shift, Onsite, hybrid, and/or remote Full-time benefits are the following: Medical, dental, vision, paid time off, paid sick time, 403(b) retirement program, life insurance plans, shift differentials, workers' compensation Leadville, Colorado, is a historic Victorian-era mining town and the highest incorporated city in the United States, situated at 10,152 feet-nearly two miles above sea level. Nestled in the heart of the Rocky Mountains and surrounded by iconic 14,000-foot peaks such as Mount Elbert and Mount Massive, Leadville offers breathtaking alpine scenery and a truly authentic mountain-town experience. Unlike larger resort communities known for luxury retail and high tourist traffic, Leadville retains its genuine Colorado character. The town is known for its welcoming, community-focused atmosphere, historic architecture, and rich mining heritage. With no major chain stores and a vibrant mix of long-time residents, outdoor enthusiasts, and local families, Leadville offers a distinctive environment where neighbors know each other and small-town values remain strong. Leadville has a close-knit population of approximately 2,600-3,000 residents, with roughly 7,700 people across Lake County. The area offers a peaceful rural-suburban setting without the congestion of larger mountain destinations. Residents enjoy exceptional year-round outdoor recreation, including hiking, biking, and fishing at nearby lakes such as Turquoise Lake and Twin Lakes. Winter activities include skiing and snowshoeing at Ski Cooper, a family-friendly ski area just outside town. The community also hosts renowned endurance events such as the Leadville Race Series, attracting athletes from around the world. St. Vincent General Hospital District-commonly known as St. Vincent Health-has served the Leadville community since the late 1800s, with roots dating back to 1879. As a critical access hospital, the organization provides essential healthcare services to local residents and visitors across Lake County and the surrounding high-country region. St. Vincent Health offers a comprehensive range of services, including: 24/7 emergency department and ambulance services Primary and family medicine Visiting specialty care (including cardiology, urology, general surgery, pain management, podiatry, and ophthalmology) Physical therapy and rehabilitation services Diagnostic imaging and laboratory services Occupational health and sleep studies The organization is known for its collaborative, team-oriented culture, where healthcare professionals work closely together in a supportive rural hospital environment. Employees often cite the opportunity to make a meaningful impact in a small community, maintain a strong work-life balance, and enjoy competitive benefits- including retirement plans, shift differentials, and benefits eligibility for many part-time roles. Working at St. Vincent Health offers the unique opportunity to combine a rewarding healthcare career with an exceptional mountain lifestyle. For individuals seeking purposeful work, strong community connections, and access to world-class outdoor recreation, Leadville provides a rare and inspiring place to live and serve. Requirements High school diploma or GED required Associate degree in healthcare administration, business, health information management, or a related field preferred Bachelor's degree in a related field preferred Medical billing certification preferred, but not required Minimum of 4-5 years of medical billing and collection experience, required Minimum of 3 years of related billing and collection experience within a hospital or health system setting preferred Experience working with Medicare, Medicaid, commercial insurance, workers ' compensation, and other third-party payers required Previous experience working with Electronic Health Records (EHR), patient accounting systems, and payer portal required Previous experience handling Protected Health Information (PHI) and demonstrated knowledge of HIPAA privacy and confidentiality requirements required Working knowledge of hospital revenue cycle processes, payer requirements, claim forms, reimbursement methodologies, and denial management Ability to read and interpret payer contracts, remittance advice, EOBs, medical records, and payer correspondence Knowledge of timely filing requirements, authorization requirements, medical necessity, claim appeals, and payer-specific billing guidelines, and/or ability to research payer updates Knowledge of applicable federal and Colorado requirements related to workers' compensation and personal injury claims Ability to independently prioritize and manage assigned A/R inventory in an onsite, hybrid, or remote work environment Summary The Medical Billing and Collection Specialist is responsible for the accurate and timely billing, follow-up, and collection of hospital accounts across Medicare, Medicaid, Medicaid Managed Care, commercial insurance, workers’ compensation, and other third-party payers. This position reviews claims and patient accounts for accuracy and completeness, monitors outstanding accounts receivable, researches and resolves claim rejections, denials, underpayments, and non-payments, and prepares and submits claim corrections, resubmissions, and appeals as necessary. The Medical Billing and Collection Specialist must demonstrate strong knowledge of hospital revenue cycle processes, payer requirements, reimbursement methodologies, and applicable billing regulations. The position requires the ability to review payer contracts, remittance information, medical records, and supporting documentation to identify appropriate resolutions and maximize reimbursement. The specialist is responsible for maintaining thorough account documentation, identifying and escalating payer or denial trends, protecting confidential patient information, and independently managing assigned accounts receivable to support timely reimbursement and the organization's overall financial performance. Responsible for reviewing patient accounts and claims for accuracy and completeness prior to billing, including identification and resolution of information necessary for proper claim submission and adjudication. Responsible for correcting, completing, and processing claims for all payer codes. Analyze patient accounts and claims to ensure accurate and timely submission to insurance payers and identify billing, processing, reimbursement, or denial issues requiring follow-up. Perform follow-up with Medicare, Medicaid, Medicaid Managed Care, and Commercial insurance companies on unpaid insurance accounts identified through aging reports. Process appeals online or via paper submission. Assist in reconciling deposits and patient collections. Assist with billing audit-related information. Process refund requests. Communicate with the billing and credentialing coordinator to identify and resolve audit review issues. Process billing calls and questions from patients and third-party carriers. Answer/respond to correspondence related to patient accounts. Is available to answer billing and changes-related inquiries from patients, staff, Managed Care Organizations, etc. Perform timely follow-up on outstanding insurance accounts utilizing aging reports and assigned work queues. Correct and resubmit claims electronically, by payer portal, fax, mail, or other payer-required method as necessary. Investigate claim rejections, denials, underpayments, and non-payments to determine appropriate resolution. Prepare, submit, and follow up on first- and subsequent-level claim appeals, including review and submission of supporting medical documentation. Review medical records and supporting documentation to identify information necessary to support claim payment and appeal determinations. Review payer contracts, reimbursement terms, and applicable payer guidelines to identify potential underpayments or incorrect reimbursement. Document all account activity, payer correspondence, follow-up actions, appeal status, and expected next steps within the patient accounting/EHR system. Maintain working knowledge of Medicare, Medicaid, commercial payer, workers’ compensation, and personal injury billing and collection requirements. Escalate systemic payer issues, denial trends, contractual discrepancies, and other revenue cycle concerns to the Revenue Cycle Director. Communicate daily with internal and external customers via phone calls and written communications. Identify trends and carrier issues relating to billing and reimbursements. Report findings to the Revenue Cycle Director. Research, record findings, and communicate effectively with the Manager to achieve optimum performance. Pursue and participate in education to remain current with changes in the Healthcare industry. Maintain patient confidence and protect medical office operations by keeping patient information confidential. Contribute to team effort by accomplishing related results as needed. Promote effective working relations and work effectively as part of a team to facilitate the department’s ability to meet its goals and objectives. Demonstrate respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment. Attend on-site/off-site community engagement activities and on-site/off-site clinic events as needed. #J-18808-Ljbffr Kids for the Future