Medical Collections Specialist

Job Title: Medical Claims Collections Specialist - Accounts Receivable

Exemption Status: Non-Exempt
Location: Port Saint Lucie, FL

Position Summary:
Are you a detail-oriented professional with a passion for accuracy and problem-solving? We’re looking for a motivated Accounts Receivable Collections Specialist to help drive our revenue cycle forward by ensuring timely and accurate follow-up on health insurance claims.

In this key role, you'll:

• Proactively manage outstanding claims with commercial and government payers
• Investigate authorizations, resolve denials, and collaborate with providers and facilities
• Resubmit and appeal claims as needed, ensuring compliance with payer and departmental guidelines
• Work cross-functionally with the EDI/Claims Specialist and Charge Capture Coordinator during special projects and absences

You'll be instrumental in helping us streamline collections, optimize reimbursements, and support the integrity of our billing operations.

If you thrive in a fast-paced environment and are ready to make a meaningful impact in healthcare revenue cycle management — we’d love to hear from you!

Primary Responsibilities:

• Proactive Follow-Up: Conduct daily follow-up on assigned A/R accounts as outlined in the work list, ensuring timely resolution.
• Denial Management: Address denials immediately for assigned accounts to prevent timely filing issues and enhance cash flow.
• Collaborative Teamwork: Work seamlessly with colleagues to manage workloads, accommodate time off requests, and tackle special projects.
• Cross-Functional Coordination: Collaborate with EDI/claims, charge coordinators, cash applications specialists, and patient advocates to ensure a smooth revenue cycle.
• Communication Excellence: Report all issues or potential challenges to leadership promptly to maintain operational integrity.
• KPI Achievement: Meet key performance indicators and adhere to all standard operating procedures (SOPs), policies, and compliance standards related to Revenue Cycle Management and payer requirements.
• Versatile Support: Assist with other office duties as assigned by management to foster a collaborative work environment.

Position Requirements:

Education/Experience:

• High School Diploma or GED required.
• Preferred three years of experience in Accounts Receivable collections or related functions.
• Proficient understanding of reading and interpreting insurance EOBs.
• Familiarity with payer rules, coordination of benefits, and the collections and appeals processes for claims.

Knowledge/Competencies & Skills:

• Strong understanding of ICD-10 and CPT-4 codes preferred.
• Comprehension of medical terminology is beneficial.
• Familiarity with NCCI guidelines and federal/commercial insurance policies preferred.
• Excellent written, verbal, and interpersonal communication skills.
• Proficient in Microsoft Excel and Word.
• Accurate and efficient data entry skills with a strong attention to detail.
• Proficient computer software and database skills.
• Strong analytical abilities to navigate complex billing scenarios.
• Ability to multitask and thrive in a fast-paced, high-volume environment.
• Familiarity with billing software systems is preferred.

Physical Demands:

• Regularly required to sit for 4-7 hours/day and stand for 1-3 hours/day.

Job Type: Full-time
Pay: $17.50 - $22.00 per hour
Work Remotely: No

Join us and contribute to our mission of delivering exceptional service in the healthcare revenue cycle!

Job Type: Full-time

Pay: $17.50 - $22.00 per hour

Benefits:

• Dental insurance
• Health insurance
• Paid time off
• Parental leave
• Vision insurance

Experience:

• Medical Collections Specialist: 2 years (Required)

Ability to Commute:

• Port Saint Lucie, FL 34953 (Required)

Work Location: In person

Salary : $18 - $22