Medical Insurance Collections Specialist

Job Description

Job Description

A Hospital in Los Angeles is seeking an experienced Medical Insurance Collections Specialist to join its revenue cycle team. The Medical Insurance Collections Specialist role will focus on insurance follow-up and collections for HMO and PPO payers, with an emphasis on resolving outstanding balances, researching claim issues, and securing timely reimbursement. The ideal candidate for the Medical Insurance Collections Specialist role will also have experience working with UB04 claims in a hospital setting.

Key Responsibilities:

• Perform insurance collections follow-up on outstanding hospital claims with a focus on HMO and PPO payers.
• Contact insurance companies and payers to obtain claim status, secure payment, and resolve unpaid or underpaid accounts.
• Review and work hospital UB04 claims to ensure accurate billing and proper reimbursement..
• Investigate and resolve claim denials, rejections, underpayments, and payment delays.
• Submit corrected claims, supporting documentation, and appeals as needed to facilitate payment resolution.
• Follow up on aged accounts receivable and maintain productivity in line with departmental goals.
• Document all collection activity, account updates, and payer communications in the billing system.
• Collaborate with billing, coding, and patient financial services teams to resolve claim discrepancies and improve reimbursement outcomes.
• Monitor payer trends and escalate recurring issues impacting collections.

Qualifications:

• 3+ years of experience in medical insurance collections, insurance follow-up, or healthcare accounts receivable..
• Hospital billing or collections experience required.
• Strong knowledge of HMO and PPO insurance plans, payer guidelines, and reimbursement processes.
• Experience working with UB04 claims required.
• Familiarity with denial management, appeals, and claim resolution processes
• Strong attention to detail, organizational skills, and ability to manage a high-volume workload..
• Excellent communication and problem-solving skills..
• Proficiency with hospital billing systems and electronic medical records preferred.

• At least 3 years of experience in medical insurance collections, healthcare accounts receivable, or insurance follow-up.
• Prior hospital billing or hospital collections experience is required.
• Hands-on experience working with UB-04 claims in a hospital environment.
• Knowledge of denial resolution, appeal submission, and claim correction processes.
• Familiarity with payer guidelines, reimbursement practices, and insurance collection workflows.
• Strong organizational skills with the ability to manage a high-volume workload accurately.
• Effective written and verbal communication skills combined with solid analytical and problem-solving ability.
• Experience using hospital billing platforms and electronic medical record systems is preferred.