Medical Collections Specialist

About the role

At SCP Health, you’ll join a team of over 7,500 providers across 30 states and 400 healthcare facilities, working to bring hospitals and healers together in pursuit of clinical effectiveness. This role focuses on denial management within professional emergency room and hospital medicine services, ensuring reimbursement goals and days in AR are met or improved.

Responsibilities

• Review Accounts Receivable (AR) by payer daily to maintain or achieve reimbursement goals and days in AR.
• Prepare timely appeals to overturn medical necessity and other denials.
• Provide regular feedback to management based on payer research and behavior trends.
• Report weekly on payer/facility adjudication concerns.
• Improve reimbursement outcomes and resolve outstanding claims inventory.
• Identify root causes of non-payment, including coding and billing errors, documentation issues, and compliance discrepancies.
• Maintain high productivity and quality of work, achieving a minimum score of 95% on all Quality Assurance audits.
• Develop and execute effective appeals strategies to overturn denied claims.
• Prepare and submit detailed, well-documented appeals to insurance companies within specified deadlines.
• Collaborate with coding specialists to address and rectify coding-related denial issues.
• Stay current on insurance policies, guidelines, and industry changes affecting emergency room and hospital medicine services.
• Collaborate with the medical billing team to address root causes of denials and implement preventive measures.
• Provide training to billing staff on denial prevention and resolution.
• Meet production standards.
• Maintain strict confidentiality regarding individuals and strategic initiatives.
• Adhere to all compliance policies and procedures, including the SCP Health Corporate Compliance Program.

Requirements

• High School diploma or equivalent (required).
• 2+ years of experience in Medical Insurance Denials Management.
• 2+ years of experience in customer service and patient billing within the medical industry.
• Proven experience in denial management, specifically in professional emergency room and hospital medicine services.
• Experience reading Explanation of Benefits (EOBs) for Government, Commercial, PPO, HMO/IPA, and Workers’ Compensation payers.
• Ability to review and validate credits for refunds and recoupment demands.
• Intermediate ability to assess and verify patient liability, coinsurance, deductibles, and denial codes.
• Knowledge of ICD-9, ICD-10, CPT, HCPCS coding, and general claims processing practices.
• Proficiency in MS Office (Word, Excel), 10-key by touch, and familiarity with Payor Portals.
• Previous experience with patient medical billing systems (e.g., OnBase, Centricity, Way Star) is a plus.

Skills

• Understanding of the overall revenue cycle process through final account adjudication.
• Excellent written and oral communication skills.
• Strong interpersonal skills and professional demeanor.
• Meticulous, organized, and detail-oriented.
• Ability to work effectively in a team environment.
• Initiative-taking and problem-solving skills.

Work Environment

• Professional office setting.
• Continuous sitting and computer use.
• Occasional bending, kneeling, lifting, pulling, and pushing up to ten pounds.
• Elevated level of mental awareness required.

Pay

$18.00 - $26.00 USD per hour. Actual compensation will be determined based on experience, qualifications, and internal equity considerations.

Benefits

• Medical, dental, and vision insurance.
• 401(k) plan with company match.
• Paid time off and holidays.
• Professional development support.
• Employee wellness resources.

Primary location: Dallas, Texas.