Position Summary

The Collections Specialist is responsible for managing and resolving outstanding accounts receivable balances from commercial and government insurance payers. This role ensures timely reimbursement for healthcare services by following up on unpaid claims, appealing denials, and working with payers to resolve issues. The position requires strong knowledge of payer billing requirements, denial management, and insurance follow-up processes.

Key Responsibilities

Insurance AR Collections

• Review and analyze aging reports to identify delinquent insurance balances.
• Contact payers to resolve unpaid, underpaid, or denied claims.
• Submit reconsiderations, appeals, and corrected claims in accordance with payer rules.
• Document all collection activities in the billing/AR system accurately and timely.
• Prioritize high-dollar and high-risk claims to maximize cash flow.

Denial Management

• Research denial reasons and coordinate with billing, coding, or clinical staff to correct errors.
• Prepare and submit appeal letters with supporting documentation.
• Track payer denial trends and escalate systemic issues to management.

Compliance & Quality

• Ensure all collection activities are conducted in compliance with CMS, HIPAA, state, and payer regulations.
• Maintain strict confidentiality of patient health and financial information.
• Adhere to organizational policies for handling insurance follow-up and escalations.

Collaboration & Communication

• Work closely with billing, coding, authorization, and contract management teams to resolve barriers to payment.
• Communicate with payers professionally to maintain positive relationships while advocating for proper reimbursement.
• Provide feedback to management regarding payer performance and recurring claim issues.

Qualifications

Education & Experience

• High school diploma or GED required (Associate’s or Bachelor’s in Healthcare Administration preferred).
• Minimum 2 years of experience in healthcare insurance collections or AR follow-up.
• Knowledge of Medicare, Medicaid, and commercial payer billing rules.
• Experience with EHR/Practice Management systems preferred.

Skills

• Strong understanding of CPT, HCPCS, and ICD-10 coding basics.
• Excellent verbal and written communication skills.
• Strong organizational and time management abilities.
• Proficiency with Microsoft Excel and AR/billing software.
• Ability to resolve complex payer issues and follow through to resolution.