Medicare Billing & Collections Specialist

Your job is more than a job. As a Collector you’re a vital member of the healthcare financial team, researching billing issues and communicating with patients for payment resolution. But it’s more than just collecting money. You're also helping patients understand and manage their medical bills. So, you understand that working out a payment plan or finding financial options can make a real difference in someone’s life. With an empathetic approach, you simplify and walk patients through the bill resolution process during what may be a stressful time in their healthcare journey. You bring your people skills, professional attitude, and problem‑solving ability as you interact with patients, insurance companies, and healthcare providers. No problem, you say, because you’re focused on building your future in an environment committed to growth and a culture committed to personal well-being. We love your positivity. Your experiences, knowledge, skills, empathy, team mentality, and your “little something extra” all add up to you. And we’re excited to get to know you and find out what you’ll bring to this billing and collection role. Your Everyday Maintain responsibility for accurate and timely completion of daily follow‑up or denial account assignment. Identify and analyze underpayments to identify reasons for discrepancies and process denials and appeals as needed. Review posted payments and adjustments to ensure accuracy. Analyze EOBs to ensure proper reimbursement. Conduct relevant research to complete the appeals process to include assessing, complete and accurate documentation, tracking, responding to, and/or resolving appeals with third party payers in a timely manner. Communicate with payers on outstanding claims, resolve payment variances and achieve timely reimbursement. Document all activity on the patient account. Collaborate with internal departments and external organizations to ensure correct reimbursement and resolve appeals. Monitor underpaid and denied claims for trends and identify root causes and report findings to supervisor. Observe best practice processes in follow‑up and customer service activities. Participate in staff training that aligns with recognized improvement opportunities and increases understanding of Medicare/Medicaid requirements as well as general follow‑up processes. Act in accordance with LCMC Health’s mission and values, while serving as a role model for ethical behavior. Adhere to federal and state regulations related to the protection of patient information (e.g., the Health Insurance Portability and Accountability Act (HIPAA) as well as facility‑specific guidelines. The Must-Haves Minimum: A high school diploma/ GED or appropriate work experience in healthcare particularly in billing, collections, payment processing, or denial management is preferred. Preferred Qualifications & Experience Working knowledge of the revenue cycle from a hospital billing perspective 2–3 years of hospital billing and collections experience Experience managing Managed Medicare accounts within a hospital or healthcare revenue cycle environment Understanding of Medicare Advantage payer guidelines Familiarity with inpatient and outpatient hospital billing requirements Proven ability to resolve claim denials, underpayments, and billing edits with insurance payers Ability to interpret EOBs, remittance advice, and payer correspondence to identify and resolve payment discrepancies Knowledge of UB-04 billing, revenue codes, DRG/APC reimbursement methodologies, and medical necessity requirements Experience with appeals, reconsiderations, and payer escalation processes Strong analytical, organizational, and follow‑up skills Ability to manage high‑volume workloads and meet productivity expectations Excellent written and verbal communication skills, with the ability to effectively interact with payers and internal stakeholders. Work Shift Days (United States of America) LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law. The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary. #J-18808-Ljbffr