Remote Medical Collections Specialist

Overview

This remote Medical Collections Specialist role involves processing, reviewing, and verifying reimbursement claims to ensure accuracy, compliance, and timely resolution. The specialist will analyze account balances, identify discrepancies, and apply appropriate transaction codes to facilitate accurate claims processing. Collaboration with internal teams supports workflow efficiency, revenue integrity, and compliance with payer guidelines while maintaining productivity and accuracy standards.

Responsibilities

• Process and verify reimbursement claims, ensuring accuracy and compliance with payer guidelines and regulatory requirements.
• Review and resolve claim discrepancies, identifying incorrect payments, denials, or underpayments and taking appropriate action.
• Apply correct transaction codes to accounts to ensure proper claim adjudication and reimbursement flow.
• Monitor and follow up on outstanding claims to ensure timely resolution and payment collection.
• Collaborate with revenue cycle teams and payers to investigate claim denials and appeal decisions when necessary.
• Research and interpret payer policies to ensure adherence to reimbursement requirements and claim submission rules.
• Document account actions accurately and thoroughly in appropriate systems, maintaining compliance with department protocols.
• Identify process improvement opportunities to increase efficiency and streamline reimbursement workflows.
• Maintain strict confidentiality of patient and financial information, ensuring compliance with HIPAA and corporate policies.
• Perform other duties as assigned.
• Comply with all policies and standards.

Qualifications

• High School Diploma or GED required.
• Associate Degree or coursework in Accounting, Finance, Healthcare Administration, or related field preferred.
• 0-1 years of experience in medical billing, reimbursement, claims processing, or accounts receivable required.
• Experience with payer reimbursement policies, claim adjudication, and healthcare revenue cycle operations preferred.

Knowledge, Skills, and Abilities

• Strong knowledge of medical billing, reimbursement procedures, and payer guidelines.
• Familiarity with claim submission, denial management, and appeals processes.
• Ability to analyze account balances, identify discrepancies, and apply appropriate adjustments.
• Proficiency in electronic health records (EHR), billing software, and reimbursement systems.
• Strong problem-solving and critical-thinking skills to ensure accurate claims resolution.
• Effective communication and collaboration skills for working with payers, revenue cycle teams, and internal departments.
• Knowledge of HIPAA, compliance regulations, and healthcare reimbursement standards.

Compensation and Benefits

• Paid Time Off (PTO).
• Comprehensive health benefits including medical, dental, and vision coverage.
• 401(k) plan with company match.
• Tuition reimbursement.

Location

• This is a fully remote position.

Additional Information

• Applicants must be authorized to work in the U.S. for any employer.
• This position is not eligible for immigration sponsorship now or in the future.