Collections Specialist

OrthoAtlanta•Fayetteville, GA

About The Position

The Collections Specialist is responsible for ensuring timely reimbursement for services rendered by managing insurance accounts receivable, following up on outstanding claims, resolving denials, and collecting patient balances. This role works closely with insurance carriers, patients, and internal teams to ensure accurate claim processing and timely payment while delivering exceptional customer service.

Requirements

High school diploma or equivalent required.
Minimum of one year of medical billing, collections, or accounts receivable experience.
Knowledge of medical billing processes, CPT and ICD-10 coding, and insurance reimbursement.
Understanding of medical accounts receivable and collection procedures.
Familiarity with commercial insurance plans, HMO, PPO, Managed Care, Medicare, and Medicaid.
Proficiency with Microsoft Office applications.
Strong analytical, organizational, and problem-solving skills.
Ability to work independently while managing multiple priorities.
Excellent verbal and written communication skills.
Professional demeanor with a high level of discretion and attention to detail.

Nice To Haves

Experience with Epic EMR is preferred.

Responsibilities

Monitor and follow up on outstanding insurance claims to ensure timely reimbursement.
Investigate, resolve, and resubmit denied or underpaid claims within payer filing deadlines.
Prepare and submit clean, accurate claims to third-party payers.
Review payer contracts, explanation of benefits (EOBs), and payment activity to ensure proper reimbursement.
Research claim issues and prepare detailed appeals with supporting documentation.
Work closely with practice staff to obtain required documentation and ensure complete patient records.
Communicate with patients regarding insurance balances, out-of-pocket expenses, and payment plan options.
Maintain accurate documentation of collection efforts, insurance communications, and account activity within the electronic health record.
Follow departmental policies, procedures, and best practices for account resolution and collections.