Hospital Medical Collections Specialist

Job Description

Job Description

We are looking for a Hospital Medical Collections Specialist to join a healthcare organization in the San Fernando Valley. The Hospital Medical Collections Specialist supports the revenue cycle by following up on outstanding hospital accounts, resolving payer issues, and helping improve reimbursement outcomes across inpatient and outpatient services. The Hospital Medical Collections Specialist must bring strong hospital billing and collections experience, along with a working knowledge of managed care, government, and commercial insurance plans.

Responsibilities:

• Pursue payment on outstanding hospital claims by reviewing account status, contacting payers, and addressing barriers that delay reimbursement.

• Investigate denials, underpayments, and rejected claims, then take appropriate action through corrections, reconsiderations, or formal appeals.

• Manage collections activity across a range of hospital accounts, including inpatient and outpatient balances tied to commercial and managed care plans.

• Work through payer-specific requirements for Medicare managed care, Medi-Cal managed care, PPO, HMO, and other commercial coverage types to secure accurate payment.

• Document follow-up activity thoroughly and maintain organized account notes to support timely resolution and audit readiness.

• Partner with internal revenue cycle and billing teams to clarify account issues, correct claim data, and reduce preventable payment delays.

• Review aging accounts to prioritize high-impact follow-up and escalate complex reimbursement issues when needed.

• Contribute to onboarding and knowledge-sharing efforts for entry-level collection staff as needed.

• At least 3 years of experience in hospital billing and collections.
• Hands-on knowledge of hospital revenue cycle processes for both inpatient and outpatient services.
• Experience handling denials, appeals, payment follow-up, and account resolution within a hospital setting.
• Familiarity with Medicare managed care, Medi-Cal managed care, HMOs, PPOs, and commercial insurance plans.
• Working knowledge of medical billing practices, payer guidelines, and reimbursement workflows.
• Strong analytical and problem-solving skills with attention to account detail and follow-through.
• Ability to communicate effectively with payers and internal teams in a detail-focused, results-driven manner.