Collections Specialist

Essential Duties And Responsibilities

• Follow up on outstanding insurance and patient balances to secure timely payment
• Investigate and resolve denied, rejected, or underpaid claims with Medicaid, managed care organizations (MCOs), and commercial insurance payers
• Review remittance advice (RA/EOB) and identify payment discrepancies or trends
• Submit claim corrections, reconsiderations, appeals, and supporting documentation as needed
• Maintain accurate documentation of account activity within billing systems
• Work aging reports and prioritize accounts based on timely filing limits and reimbursement impact
• Communicate with insurance representatives regarding claim status, authorization issues, and payment resolution
• Collaborate with admissions, utilization review, credentialing, and billing teams to resolve claims issues
• Identify recurring billing or authorization issues and escalate trends to leadership
• Ensure compliance with payer guidelines, company policies, HIPAA, and confidentiality standards
• Assist with patient account inquiries and payment arrangements as needed
• Maintain productivity and collection goals established by the organization

Qualifications

• High school diploma or equivalent required; associate’s degree preferred
• Minimum of 2 years of healthcare collections or medical billing experience preferred
• Behavioral health, residential treatment, or Medicaid collections experience strongly preferred
• Knowledge of insurance claims processing, denials management, and appeals
• Familiarity with Medicaid and managed care payer guidelines
• Strong analytical, organizational, and problem-solving skills
• Excellent communication and customer service abilities
• Ability to manage multiple accounts and deadlines effectively
• Proficiency in Microsoft Office Suite and healthcare billing systems

Preferred Skills

• Experience with behavioral health, PRTF, or residential treatment billing
• Understanding of authorizations, eligibility verification, and coordination of benefits
• Knowledge of multi-state Medicaid billing processes

Schedule

Subject to change based on the need of the program*