Medical Collections Specialist

Job Description

Job Description

We are looking for a Medical Collections Specialist to join a healthcare team in Sacramento, California. This contract-to-permanent opportunity is ideal for someone who brings strong experience in insurance follow-up, denial resolution, and patient balance discussions within a high-volume revenue cycle environment. The role is onsite and focuses on reviewing claim outcomes, pursuing reimbursement, and helping ensure accounts are resolved accurately and efficiently.

Responsibilities:
• Review payer contracts and reimbursement terms to determine correct allowed amounts and identify underpayments.
• Interpret Explanation of Benefits statements to evaluate claim decisions and confirm financial responsibility.
• Investigate denied, delayed, or partially paid claims and take appropriate action to secure proper reimbursement.
• Prepare clear, persuasive appeals that address payer findings and support claim reconsideration.
• Communicate with insurance carriers to resolve billing discrepancies, payment issues, and adjudication concerns.
• Speak with patients regarding outstanding balances, explaining how copays, deductibles, coinsurance, and out-of-pocket limits affect what they owe.
• Maintain consistent follow-up on assigned accounts while meeting productivity expectations in a fast-moving workload.
• Apply analytical judgment to determine the most effective next steps for account resolution and escalation when needed.
• Collaborate with team members to support collection goals and maintain quality standards across account follow-up activities.• Experience in medical collections, accounts receivable follow-up, or healthcare reimbursement functions.
• Strong understanding of Explanation of Benefits documents and insurance claim adjudication processes.
• Knowledge of patient financial responsibility concepts, including copays, deductibles, coinsurance, and out-of-pocket maximums.
• Familiarity with commercial insurance plans, PPO products, and Medicare Advantage reimbursement structures.
• Proven ability to write effective appeals for denied or underpaid medical claims.
• Confidence interacting with both insurance representatives and patients regarding account balances and claim outcomes.
• Ability to manage a high-volume workload, stay organized under pressure, and consistently achieve performance targets.
• Working knowledge of medical terminology and revenue cycle processes related to claim denials and reimbursement.