Senior Medical Collections Representative

About the role

Are you an experienced medical collections professional who thrives on solving complex billing challenges and driving account resolution? We are seeking a Sr. Medical Collections Representative to join a growing healthcare revenue cycle team supporting a major accounts clean-up initiative. This is an excellent opportunity for someone with strong denial management, insurance follow-up, and Epic experience who enjoys making a direct impact on revenue recovery and patient account resolution.

Responsibilities

• Investigate and resolve denied, unpaid, and underpaid insurance claims.
• Work assigned No Pay/No Response and denial work queues to drive account resolution.
• Submit claims accurately and timely in accordance with payer guidelines.
• Utilize payer portals, remittance advice, and direct payer communication to research and resolve claim issues.
• Analyze denials, identify root causes, and determine appropriate corrective actions.
• File appeals and obtain supporting documentation to secure reimbursement.
• Review CPT, ICD-10, HCPCS codes, coordination of benefits, registration issues, and payer contracts to identify and resolve discrepancies.
• Collaborate with departments including Coding, Medical Records, Case Management, Billing, and Clinical Teams to address claim concerns.
• Perform account adjustments and ensure balances are maintained accurately.
• Identify payment and denial trends and communicate findings to leadership.
• Maintain detailed documentation within the patient accounting system.
• Communicate with guarantors and families when additional information or action is required for claim resolution.
• Meet established production and quality standards while balancing daily workloads and special projects.

Requirements

• Certified Medical Coder (Required)
• Minimum 3 years of experience in medical billing, collections, payment posting, revenue cycle operations, or related healthcare financial roles
• Proven experience working with Epic in a billing, collections, or revenue cycle environment
• Strong Understanding Of Insurance follow-up and denial management
• Hospital and physician billing practices
• Third-party reimbursement processes
• HIPAA regulations and patient privacy standards
• CPT, ICD-10, and HCPCS coding
• Coordination of Benefits (COB)
• Payer contract interpretation
• Excellent analytical, problem-solving, and critical thinking abilities
• Strong communication and documentation skills
• Ability to work independently while managing multiple priorities in a fast-paced environment

Qualifications

• Experience with hospital, professional, or home care claims
• Experience in large-scale revenue cycle clean-up or remediation projects
• Familiarity with payer portals and denial resolution workflows