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Medical Collections Specialist

Medical Collections Specialist

Job Description

Job Function

Promote a patient-centric environmental approach to working medical collections.  Manage the accounts receivables balances for assigned facilities by reducing the AR to cash, resolving claim denials, providing direct oversight to payor and facility specific processes surrounding the AR, and effectively working with a team of offshore staff to work ETM tasks.

Job Responsibilities
Primary Functions:
  • Review AR by payor on a daily basis to ensure reimbursement goals and days in AR are maintained or achieved
    • Prepare denial and rejection trends reports to supervisor or Manager 
    • Prepare reports for facility analysis
  • Provide feedback to management based on research and calls to payors to establish payor behavior trends.
    • Provide weekly feedback on payor/facility adjudication concerns 
  • Document and ensure each Schumacher Group Special Arrangement is processed correctly and returning the expected results
  • Monitor and maintain a high level of productivity and quality of work
    • Research and resolve invoices routed to the Specialists Views, including Escalated Views, CE View, Correspondence View, CPE View, Rejection View, etc.  
    • Prepare appeals relating to past timely filing, medical necessity, underpayment of invoices, and other various denials, in a timely manner, in order to achieve monthly cash goals.  
    • Produce a minimum of 45 outcomes per day on Medical Collection Views unless otherwise assigned
    • Achieve a minimum score of 90% on all QA audits.
  • Keep management abreast of both successes and problems as they occur

Secondary Functions:
  • Participate in various committees as required
  • Participate in problem resolution at all levels
  • Assist in projects as required
  • Other duties as assigned

Job Requirements

Educational Qualifications
  • High school diploma or GED

Professional Qualifications
  • Strong analytical and problem solving skills
  • Strong desktop PC skills in MS Excel
  • Ability to work well in a team environment
  • Professional attitude and demeanor

Previous Experience
  • Minimum of 3 years Accounts Receivable experience in the healthcare industry
  • Knowledge of the GE Centricity Business product is preferred but not mandatory

Special Skills
  • Understand payer EOBs and identify posting errors of payments and adjustments.
  • Must be extremely detail oriented and organized, a self –starter capable of tracking to deadlines and meeting goals.
  • Ability to work autonomously and as a team member, with little supervision required once a goal is assigned.
  • Excellent verbal and written communications skills.
  • May require sitting for long periods of time; also stooping, bending, and reaching for files and supplies.
  • Requires manual dexterity sufficient to operate a computer keyboard, answer a telephone, run a copier and other office equipment as necessary.
  • Vision must be correctable to 20/20.

Job Snapshot

Employment Type Full-Time
Job Type Accounting, Health Care, Insurance
Education High School
Experience At least 3 year(s)
Manages Others Not Specified
Industry Healthcare - Health Services
Required Travel Not Specified
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Medical Collections Specialist

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