Job Description
Job Description
Join a mission-driven healthcare team where your expertise directly impacts patient care and organizational success. We are seeking an experienced Hospital Medical Collections Specialist to support revenue cycle operations in a fast-paced hospital environment. This Hospital Medical Collections Specialist opportunity is ideal for a detail-oriented professional with a strong background in hospital billing, insurance follow-up, and complex claims resolution across inpatient and outpatient accounts.
In this role, you will play a critical part in maximizing reimbursement, resolving denied and underpaid claims, and partnering with internal teams to improve financial outcomes. The ideal candidate thrives in a collaborative environment, understands payer regulations, and is highly skilled in navigating hospital collections with urgency and accuracy.
What You’ll Do
- Drive resolution of outstanding hospital claims by reviewing account status, contacting payers, and securing timely reimbursement.
- Manage collection activity across a diverse portfolio of insurance plans, including Medicare Managed Care, Medi-Cal Managed Care, commercial payers, and HMO/PPO products.
- Research denied and underpaid claims, identify root causes, and prepare compelling appeals with supporting documentation.
- Handle both inpatient and outpatient hospital billing accounts while ensuring compliance with payer requirements and contractual guidelines.
- Analyze payment activity, billing edits, and account trends to identify reimbursement barriers and implement corrective actions.
- Maintain thorough and accurate documentation of payer communication, follow-up activity, and account resolution steps.
- Collaborate closely with billing, coding, and revenue cycle teams to resolve claim discrepancies and improve collection performance.
- Adapt to department workflows and support Collector I-level processes and training initiatives as needed.
What We’re Looking For
- Proven experience in hospital billing and medical collections within an acute care or healthcare revenue cycle environment.
- Strong understanding of managed care plans, denial management, appeals, and payer follow-up processes.
- Experience working with inpatient and outpatient hospital claims.
- Excellent analytical, communication, and problem-solving skills.
- Ability to prioritize workload, meet deadlines, and work efficiently in a high-volume environment.
- Strong attention to detail and commitment to accuracy.