Collections Specialist – Accounts Receivable & Revenue Cycle Management

Location: Remote / Hybrid (Based on Business Needs)
Schedule: Monday – Friday | Standard Business Hours
Pay Rate: 22.50
Schedule: Regular Business Hours
Target Start Date: ASAP
Benefits: Health, Dental, Vision

Department: Revenue Cycle Management / Collections

Position Overview

We are seeking a detail-oriented and analytical Collections Specialist to join our Revenue Cycle Management team. This role is responsible for managing aged accounts receivable, resolving denied and unpaid insurance claims, researching payment discrepancies, and collaborating with internal departments and insurance payers to maximize reimbursement.

The ideal candidate will have experience in healthcare collections, insurance billing, claims resolution, denial management, and accounts receivable follow-up. This position plays a critical role in improving collection rates, reducing bad debt, and ensuring the financial health of the organization through proactive management of outstanding claims and payer accounts.

Key Responsibilities:

Aged Trial Balance (ATB) Management

• Manage and work Aged Trial Balance (ATB) reports, consisting of claims with outstanding balances that have not reached a zero balance.
• Review ATB inventories to improve collection rates, reduce bad debt, and support quarterly reserve risk goals.
• Run and analyze ATB queries, typically reviewing claims from 60 days back across the preceding four months.
• Research outstanding claims using internal systems, reports, and supporting documentation.
• Utilize spreadsheets and V-Lookup functions to match denial codes, action codes, denial reasons, and resolution actions.

Denial Management & Claims Research

• Review Explanation of Benefits (EOBs) and payer correspondence received from the Cash Team.
• Analyze denial reasons and determine appropriate corrective actions.
• Research additional denial information through Filebound and other internal resources.
• Document findings and maintain accurate records of claim activity.
• Collaborate with Plan Owners to resolve claim denials and reimbursement issues.

Payment Resolution & Credit Balance Review

• Investigate credit balances and payment discrepancies.
• Determine whether duplicate payments or overpayments exist.
• Identify whether refunds are owed to insurance carriers or members.
• Prepare and process refund requests when necessary.
• Redirect misapplied payments to the appropriate invoices or claims.

Claims Follow-Up & Payer Communication

• Research claims with no payment or denial received.
• Initiate claim resubmissions when appropriate.
• Contact insurance payers to verify claim status and obtain resolution updates.
• Follow up on previously resubmitted claims that remain unresolved.
• Work collaboratively with internal stakeholders to ensure timely claim resolution.

Write-Off Management

• Evaluate accounts for potential write-off consideration.
• Submit write-off recommendations for supervisory approval.
• Coordinate additional approvals from Finance Management when required based on established thresholds.
• Ensure all write-off activity complies with company policies and procedures.

Trend Analysis & Process Improvement

• Identify recurring payer trends, denial patterns, and reimbursement issues.
• Escalate plan setup or payer configuration concerns for correction.
• Partner with Payer Relations and payer representatives to resolve systemic payment issues.
• Recommend process improvements that support increased reimbursement and reduced receivable aging.

Documentation & Compliance

• Maintain detailed documentation of all collection activities, including:
  • Write-offs
  • Resubmissions
  • Phone calls
  • Email correspondence
  • Account research and resolutions
• Ensure all activities are properly documented and stored for auditing and compliance purposes.

Claims Resubmission Responsibilities

Claims may require resubmission when:

• No payment or denial has been received.
• A denial requires claim corrections before reconsideration.

Responsibilities include:

• Initiating claim resubmissions.
• Coordinating with Claims teams and Plan Owners to ensure required corrections are completed.
• Ensuring appropriate updates are made to electronic (837) claims prior to resubmission.
• Monitoring unresolved claims and following up with payers as necessary.

Challenges & Considerations

• Limited system visibility exists for tracking resubmitted claims.
• Success requires close collaboration with Claims teams and Plan Owners to ensure timely corrections and submissions.

Payment Received After (PRA) Review

Payment Received After Query

The Payment Received After (PRA) process identifies claims that receive payment after a balance has already been written off.

Responsibilities Include:

• Reviewing weekly PRA reports provided by leadership.
• Researching payment activity to verify proper claim application.
• Identifying and correcting misapplied payments.
• Redirecting payments to the correct invoice when appropriate.
• Unapplying payments when the correct invoice cannot be determined.
• Ensuring accurate account reconciliation and payment posting.

Required Qualifications

• Experience in healthcare collections, accounts receivable, medical billing, or revenue cycle operations.
• Strong knowledge of insurance claims processing and denial management.
• Experience interpreting EOBs and researching claim status.
• Familiarity with payment posting, refunds, write-offs, and account reconciliation.
• Proficiency with Microsoft Excel, including V-Lookups and data analysis functions.
• Excellent analytical, organizational, and problem-solving skills.
• Strong written and verbal communication skills.
• Ability to prioritize workload and manage multiple accounts simultaneously.

Preferred Qualifications

• Experience working with commercial, government, and managed care payers.
• Knowledge of electronic claims submission and 837 transactions.
• Familiarity with Filebound or similar document management systems.
• Previous experience in healthcare revenue cycle management or insurance collections.

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