Collections Specialist

ForMotion•Nashville, TN

About The Position

The Collections & AR Specialist manages assigned accounts receivable balances and supports timely resolution of outstanding payer and patient accounts. The role performs post-billing follow-up, researches unpaid or underpaid claims, and works with payers and patients to resolve reimbursement issues. It ensures accurate account documentation, follows established procedures, and collaborates with internal teams to support efficient revenue cycle operations. The specialist monitors and works assigned payer and patient accounts using documented prioritization criteria, including aging, dollar value, filing and appeal deadlines, payer requirements, and collectability. The position researches denials, partial payments, underpayments, recoupments, and payment delays; submits corrected claims and appeals when required; communicates with payers and patients through approved channels; and documents account activity and follow-up actions. The role protects filing and appeal rights, escalates deadlines and complex issues as appropriate, and coordinates with billing, coding, authorization, clinical documentation, contracting, cash posting, and operational teams to resolve root causes. It also supports routine accounts receivable reporting and reconciliation, and may assist the billing team with submissions when needed and directed by a supervisor. The position is remote or hybrid depending on organizational needs. It involves frequent communication with clinics, payers, and internal teams in a fast-paced environment with strict timelines and competing priorities.

Requirements

High school diploma or equivalent.
At least 2 years of healthcare accounts receivable, collections, or denial management experience.
Strong knowledge of payer reimbursement methodologies and denial codes.
Experience working Medicare, Medicaid, and commercial payer accounts receivable.
Familiarity with EOBs, ERAs, and payer portals.
Persistence and strong problem-solving skills.
Excellent written and verbal communication skills.
Ability to analyze denial data and identify root causes.
Results-driven approach focused on cash acceleration and resolution.

Nice To Haves

Associate degree.
Experience with appeal writing and medical necessity denials.
Certified Revenue Cycle Representative (CRCR) or similar certification.
Background in a high-volume or complex payer environment.

Responsibilities

Monitor and work assigned payer and patient accounts according to aging, dollar value, filing and appeal deadlines, payer requirements, and collectability.
Perform routine follow-up to resolve outstanding claims and balances while meeting productivity and quality standards.
Research and resolve denials, partial payments, underpayments, recoupments, and payment delays using remittance codes, payer policies, contract terms, claim history, and supporting documentation.
Submit corrected claims, appeals, and supporting documentation as required.
Communicate with payers about claim status and reimbursement issues.
Follow up on payer and patient balances through approved channels and workflows, using accurate balance information and respectful, compliant communications.
Document contact attempts, responses, reference numbers, actions, next steps, owners, and follow-up dates in the designated system.
Protect timely-filing, reconsideration, and appeal rights; escalate approaching deadlines, high-dollar accounts, systemic payer issues, and exhausted appeal options under departmental policy.
Use approved adjustment, write-off, bad-debt, payment-plan, and financial assistance processes as applicable.
Coordinate with billing, coding, authorization, clinical documentation, contracting, cash posting, and operational teams to correct root causes and prevent recurrence.
Maintain accurate account documentation in billing systems and follow payer requirements, HIPAA, organizational policies, applicable federal and state collection requirements, approved communication practices, and financial assistance and refund policies.
Collaborate with billing, coding, and customer service teams to resolve reimbursement issues; escalate complex issues to leadership when appropriate.
Assist the billing team with submissions when needed, time permits, and directed by a supervisor.
Maintain collection activity records and account documentation; assist with routine AR reporting and reconciliation activities.
Work toward company targets for days in accounts receivable, denial rate, accounts receivable over 90 days, and net collection rates.