Medical Collections Specialist

Medical Collections Specialist

We are looking for a skilled Medical Collections Specialist to join our team in Irvine, California. This is a contract-to-permanent position, offering an excellent opportunity to grow your career in a dynamic healthcare environment. The ideal candidate will play a vital role in managing accounts receivable, resolving payment discrepancies, and ensuring compliance with industry regulations.

Responsibilities :

Manage accounts receivable by following up on outstanding payments, payment errors, and claim denials.

Analyze insurance Explanation of Benefits (EOBs) and initiate appeals when necessary to resolve discrepancies.

Maintain detailed documentation of account issues, resolutions, and follow-up actions for patient records.

Prepare and send required documentation via mail or other channels to support claims processing.

Stay informed about commercial and managed care pricing models, as well as relevant rules and regulations.

Ensure compliance with organizational policies and healthcare laws, safeguarding patient confidentiality at all times.

Participate in compliance training sessions and promptly report any concerns or incidents to management.

Utilize systems such as EHR platforms, Epic Software, and IBM AS / 400 to ensure efficient claims and collections processes.

Support the team by performing additional tasks as directed by supervisors or management.

Contribute to the overall success of the department by collaborating with colleagues to meet organizational goals.

Requirements :

Proven experience in medical collections or accounts receivable management within the healthcare industry.

Proficiency with tools such as Accurint, Dynamic Data Exchange (DDE), EHR systems, Epic Software, and IBM AS / 400.

Solid understanding of billing functions, claim administration, and appeals processes.

Familiarity with commercial insurance and managed care regulations, including pricing models and compliance standards.

Strong problem-solving skills to address payment discrepancies and resolve claim denials.

Excellent communication and organizational abilities to maintain accurate documentation and coordinate with team members.

Knowledge of confidentiality requirements and experience handling sensitive patient information securely.

Ability to work independently as well as collaboratively in a fast-paced, results-driven environment.