Collections Specialist - Remote

Surgery Partners, Inc•,

2d•Remote

About The Position

The Collections Specialist is responsible for researching unpaid claims, determining denial root causes, and performing follow-up actions to ensure timely claim adjudication. This role involves identifying and processing secondary or tertiary insurance billing, staying informed about payer regulations, and communicating payer trends to management. The specialist will document all account resolution actions, review and execute payer logic within negotiated contracts, and prioritize workflow to reduce bad debt and days in Accounts Receivable (AR). Meeting productivity and audit standards is essential, along with performing other duties as assigned by management.

Requirements

High School Diploma or equivalent.
Knowledge of medical terminology, CPT and HCPCs.
Proficient in analyzing claims to ensure reimbursement aligns with contractual obligations.
Ability to organize work and manage change.
Results oriented & thrives in a fast-paced, high-energy environment.
Ability to develop and maintain good communication and establish positive working relationships with payers, peers, and leadership.
Strong written and verbal communication skills.

Nice To Haves

2-3 years of medical collections experience preferred.

Responsibilities

Research unpaid claims, determine denial root cause, and perform appropriate follow up actions to ensure timely claim adjudication.
Identify and take appropriate action for the billing of secondary or tertiary insurances.
Keep informed on all current applicable third-party payer regulations and requirements.
Communicate payer trends and patterns to management.
Document within a patient’s record all actions taken related account resolution.
Review, comprehend and execute payer logic within negotiated contracts.
Prioritize workflow to reduce or eliminate bad debt flow resulting in a reduction in days in AR.
Meet and maintain productivity and audit standards.
Other duties as assigned by management.