Revenue Cycle Collections Specialist

New Life Medicine•Johnson City, TN

3d•Onsite

About The Position

The Revenue Cycle Collections Specialist is responsible for the proactive management, follow-up, and resolution of outstanding insurance accounts receivable to maximize reimbursement and minimize aging balances. This position is accountable for researching unpaid, underpaid, and denied claims; engaging insurance payers to secure appropriate reimbursement; and resolving outstanding balances in a timely manner. The ideal candidate demonstrates strong analytical skills, persistence, payer reimbursement knowledge, and a high degree of ownership over assigned accounts receivable.

Requirements

High school diploma or equivalent required; associate degree preferred.
Minimum 2 years of medical insurance collections, accounts receivable, or denial management experience preferred.
Strong understanding of Medicare, Medicaid, and commercial insurance reimbursement.
Experience with claim status research, denial resolution, appeals, and payer follow-up.
Working knowledge of CPT, ICD-10-CM, insurance terminology, and explanation of benefits (EOB) documentation.
Proficiency with EHR/practice management systems, payer portals, and Microsoft Excel.
Strong communication, negotiation, organizational, and problem-solving skills.

Nice To Haves

Experience with Athenahealth or comparable practice management platforms.
Certified Revenue Cycle Representative (CRCR), Certified Professional Biller (CPB), or similar credential.
Experience managing complex or aged insurance receivables.
Familiarity with payer contracts, fee schedules, and reimbursement variance analysis.
Experience in a multispecialty or multi-location physician practice.

Responsibilities

Manage an assigned portfolio of insurance accounts receivable, prioritizing claims based on age, balance, payer, and reimbursement risk.
Perform timely follow-up on unpaid, delayed, denied, and underpaid claims.
Contact insurance payers through portals, telephone, and other approved communication channels to determine claim status and facilitate resolution.
Investigate outstanding balances and identify root causes of payment delays.
Resolve outstanding claims through appropriate follow-up, corrected claims, reconsiderations, appeals, or other authorized processes.
Ensure claims are addressed before applicable timely filing and appeal deadlines.
Maintain accurate account notes documenting actions, payer communications, and next steps.
Analyze claim denials to identify underlying causes and appropriate corrective actions.
Prepare and submit appeals, reconsiderations, and supporting documentation.
Identify patterns in payer denials, payment discrepancies, and reimbursement practices.
Collaborate with billing specialists and clinical personnel to correct recurring claim issues.
Escalate systemic payer issues, contractual disputes, and unresolved claims to RCM leadership.
Review insurance payments for accuracy against applicable contractual allowances and expected reimbursement.
Identify and pursue underpayments and inappropriate claim adjustments.
Research payment discrepancies, coordination-of-benefits issues, and outstanding payer obligations.
Recommend account adjustments or write-offs when appropriate, subject to established authorization policies.
Assist in reconciling outstanding claims and ensuring accurate A/R reporting.
Work assigned accounts consistently according to established aging and prioritization protocols.
Focus on reducing balances aged beyond 60 and 90 days.
Identify claims at risk of becoming uncollectible and escalate promptly.
Maintain a documented follow-up plan for unresolved accounts.
Provide feedback regarding payer trends, operational barriers, and opportunities to accelerate reimbursement.
Participate in periodic A/R reviews and performance improvement initiatives.