Medical Insurance Collections Specialist

Job Description

Job Description

Join a mission-driven healthcare team where your expertise directly impacts patient care and organizational success. We are seeking an experienced Hospital Medical Collections Specialist to support revenue cycle operations in a fast-paced hospital environment. This Hospital Medical Collections Specialist opportunity is ideal for a detail-oriented professional with a strong background in hospital billing, insurance follow-up, and complex claims resolution across inpatient and outpatient accounts.

In this role, you will play a critical part in maximizing reimbursement, resolving denied and underpaid claims, and partnering with internal teams to improve financial outcomes. The ideal candidate thrives in a collaborative environment, understands payer regulations, and is highly skilled in navigating hospital collections with urgency and accuracy.

What You’ll Do

• Drive resolution of outstanding hospital claims by reviewing account status, contacting payers, and securing timely reimbursement.
• Manage collection activity across a diverse portfolio of insurance plans, including Medicare Managed Care, Medi-Cal Managed Care, commercial payers, and HMO/PPO products.
• Research denied and underpaid claims, identify root causes, and prepare compelling appeals with supporting documentation.
• Handle both inpatient and outpatient hospital billing accounts while ensuring compliance with payer requirements and contractual guidelines.
• Analyze payment activity, billing edits, and account trends to identify reimbursement barriers and implement corrective actions.
• Maintain thorough and accurate documentation of payer communication, follow-up activity, and account resolution steps.
• Collaborate closely with billing, coding, and revenue cycle teams to resolve claim discrepancies and improve collection performance.
• Adapt to department workflows and support Collector I-level processes and training initiatives as needed.

What We’re Looking For

• Proven experience in hospital billing and medical collections within an acute care or healthcare revenue cycle environment.
• Strong understanding of managed care plans, denial management, appeals, and payer follow-up processes.
• Experience working with inpatient and outpatient hospital claims.
• Excellent analytical, communication, and problem-solving skills.
• Ability to prioritize workload, meet deadlines, and work efficiently in a high-volume environment.
• Strong attention to detail and commitment to accuracy.

• At least 3 years of experience in hospital billing and collections within a healthcare or hospital environment.
• Working knowledge of medical billing, medical collections, denials management, and appeals processing.
• Hands-on experience with hospital revenue cycle operations for both inpatient and outpatient accounts.
• Familiarity with Medicare managed care, Medi-Cal managed care, commercial insurance, and HMO/PPO reimbursement structures.
• Ability to review account details, identify payment issues, and resolve balances through organized follow-up.
• Strong written and verbal communication skills for payer outreach, documentation, and appeal preparation.
• High attention to detail and the ability to manage multiple accounts while meeting productivity expectations.