Collections Representative

Collections Representative

A leading medical institution is seeking a Collections Representative to support the accurate and timely billing and collections of inpatient, outpatient, and laboratory claims for government and third-party payers. This role is responsible for claims processing, account maintenance, reimbursement activities, and regulatory compliance while ensuring billing accuracy, maximizing reimbursement, and delivering exceptional customer service.

Collections Representative Responsibilities:

• Process, review, and submit inpatient, outpatient, and laboratory claims by verifying account information, charges, coding, authorizations, supporting documentation, and compliance with government, payer, and organizational billing requirements.
• Manage accounts throughout the billing lifecycle by researching and resolving claim edits, denials, rejections, billing exceptions, account discrepancies, adjustments, transfers, rebills, write-offs, and timely filing requirements while maintaining accurate account documentation.
• Monitor reimbursement activities by maintaining claim management systems, processing required supporting documentation, identifying billing issues, ensuring compliance with payer regulations, HIPAA, managed care contracts, and organizational policies, and supporting audits and quality initiatives.
• Communicate effectively with patients, payers, and internal departments to resolve billing inquiries, obtain missing information, address reimbursement issues, and provide professional customer service while fostering collaborative working relationships.
• Maintain productivity and quality standards by monitoring assigned accounts, identifying process improvement opportunities, supporting departmental projects, preparing reports, and ensuring accurate documentation within patient accounting systems.

Collections Representative Qualifications:

• 2-5 years of experience in Medicare billing and collections for inpatient and outpatient healthcare services.
• Knowledge of hospital billing practices, government payer regulations, managed care contracts, reimbursement processes, and healthcare revenue cycle operations.
• Experience with electronic claims processing, patient accounting systems, healthcare billing software, and payer portals is preferred.
• Proficiency with Microsoft Office, including Excel and Word, and standard office equipment.
• Excellent written and verbal communication skills with a strong customer service orientation.
• Ability to maintain accurate documentation, protect confidential patient information, and comply with HIPAA and regulatory requirements.

Shift:

• Hybrid: Training will be conducted onsite. The candidate will transition to fully remote afterwards.