Medical Collections Specialist

Senior Revenue Cycle Associate - Collections Position Details: Employment Type: Full Time Location: Remote Reports to: RCM Manager You must reside in one of these states to be eligible for this position: Arkansas    California    Kentucky Massachusetts Nevada    New Mexico Oregon     Utah     Tennessee Texas     Wyoming Job Summary: Serves as a subject matter expert (SME) for assigned revenue cycle functions while performing advanced insurance accounts receivable, denial management, appeals, self-pay collections, correspondence, and other complex revenue cycle activities. Provides functional guidance to team members and supports departmental quality, productivity, workflow improvement, and staff development. Responsibilities may vary based on departmental needs, business priorities, assigned work queues, and cross-training requirements. This position is not a formal supervisory role. Key Responsibilities: Researches and resolves the department's most complex accounts and payer issues. Acts as a resource for questions regarding payer requirements. Provides day-to-day functional guidance and technical support to staff. Assists leadership with onboarding, cross-training, and mentoring team members. Performs quality assurance reviews and provides constructive feedback to support continuous improvement. Performs collection activity to ensure proper resolution and reimbursement of claims. Research denials and write appeals where necessary. Resolves claim processing issues with third party payers and provide all information required in a timely manner; involves also working with patients to ensure timely resolution to maximize reimbursement. Understands payer guidelines for unpaid claim resolution as well as help patients understand their responsibility. Monitors and recognizes reimbursement trends, recurring denials, or workflow issues to escalate concerns to leadership. Meets goals and objectives of the department which include productivity and quality minimum standards. Resubmits clean and accurate claims to insurance companies in a timely and compliant manner. Processes payer and patient correspondence, including requests for additional information, reconsiderations, and other revenue cycle communications. Maintains accurate, complete, and timely documentation of all account activity in the patient accounting system. Maintain strict confidentiality and adhere to all HIPAA guidelines/regulations. Adherent to all corporate and department policies. Required Skills & Qualifications: Demonstrated expertise in insurance collections, denial management, reimbursement methodologies, and appeals. Ability to analyze complex reimbursement issues and recommend appropriate resolutions. Highly detail oriented and organized with critical thinking and problem-solving skills. Ability to establish and maintain effective working relationships and communicate with customers, patients and insurance companies. Strong customer service skills to de-escalate difficult calls and remain professional. Knowledgeable and proficient with payer websites and other useful resources. Ability to work independently within a remote structure with no distractions. Work Experience, Education and Certifications: High school graduate or equivalent. Minimum experience of five years working with hospital revenue cycle, patient financial services, or insurance accounts receivable. Comprehensive knowledge of payer regulations, reimbursement guidelines, and revenue cycle best practices. Benefits: Competitive salary and benefits package. Opportunities for professional development and advancement. Supportive work environment with a collaborative team. Comprehensive healthcare coverage. Retirement savings plan. Paid time off and flexible scheduling options. Student loan repayment program.