Medical Collections Specialist

Job Description

Job Description

We are looking for a Medical Collections Specialist to join our team in Sacramento, California on a contract basis. This position is ideal for someone who understands the medical revenue cycle and can confidently investigate payment discrepancies, interpret payer responses, and pursue appropriate reimbursement. The role requires strong communication, sound judgment, and the ability to manage a high volume of accounts in an in-office setting while maintaining accuracy and productivity.

Responsibilities:

• Review payer contracts and reimbursement terms to identify expected payment amounts and spot variances on outstanding accounts.

• Analyze explanation of benefits documents and claim outcomes to determine next steps for follow-up, correction, or escalation.

• Investigate denied, delayed, or underpaid claims and work directly with insurance carriers to secure proper resolution.

• Prepare clear, persuasive written appeals that support reconsideration of disputed claim determinations.

• Communicate with patients regarding account balances, coverage decisions, and the financial impact of claim adjudication.

• Apply knowledge of copays, coinsurance, deductibles, and out-of-pocket limits when evaluating patient responsibility.

• Maintain timely and effective follow-up on assigned accounts while meeting productivity targets in a fast-paced environment.

• Collaborate with team members to resolve complex accounts and contribute to overall collection performance goals.

• Hands-on experience in medical collections and accounts receivable follow-up within a healthcare setting.
• Strong understanding of medical terminology, claim denials, reimbursement practices, and revenue cycle processes.
• Ability to interpret payer contracts, explanation of benefits statements, and insurance payment calculations accurately.
• Working knowledge of insurance plan structures, including commercial coverage and Medicare Advantage products.
• Demonstrated success writing appeals and resolving denied or underpaid claims with insurance companies.
• Comfortable discussing balances and payment outcomes with patients in a detail-oriented and respectful manner.
• Proven ability to prioritize a heavy workload, make sound decisions, and perform effectively under pressure.