Collections/Appeals Specialist I - REMOTE

Community Health Systems; Sarasota (FL); Remote; USD 35,000 - 45,000; Full time

Job summary

A leading healthcare provider seeks a Collections/Appeals Specialist I to manage insurance collections and ensure compliance with regulations. The role involves effective communication with payers and documentation of account activities. Ideal candidates will have a diploma and some experience in medical collections.

Qualifications

• 0-2 years of experience in medical collections required.
• Strong understanding of medical collections processes.

Responsibilities

• Performs follow-up on outstanding insurance balances.
• Documents all actions taken on accounts.
• Ensures compliance with local, state, and federal regulations.

Skills

Problem-Solving

Communication

Attention to Detail

Education

H.S. Diploma or GED

Associate Degree in Business

Tools

AS400

Meditech

Cerner

Job description

Collections/Appeals Specialist I - REMOTE

Join to apply for the Collections/Appeals Specialist I - REMOTE role at Community Health Systems

Collections/Appeals Specialist I - REMOTE

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Join to apply for the Collections/Appeals Specialist I - REMOTE role at Community Health Systems

Job Summary

The Collections Specialist I is responsible for performing collection follow-up on outstanding insurance balances, identifying claim issues, and ensuring timely resolution in compliance with government and managed care contract terms. This role requires effective communication with insurance payers, documentation of account activity, and adherence to applicable regulations to support revenue cycle operations.

Job Summary

The Collections Specialist I is responsible for performing collection follow-up on outstanding insurance balances, identifying claim issues, and ensuring timely resolution in compliance with government and managed care contract terms. This role requires effective communication with insurance payers, documentation of account activity, and adherence to applicable regulations to support revenue cycle operations.

Essential Functions

• Performs follow-up on outstanding insurance balances within the required timeframe, obtaining payment confirmation or required documentation.
• Documents all actions taken on accounts within the appropriate system, ensuring a clear and traceable resolution process.
• Makes the required number of outbound calls to insurance payers while maintaining professional and courteous communication.
• Handles and resolves incoming correspondence within five days of receipt, updating the system with relevant information.
• Analyzes assigned accounts using AS400, Meditech, Accurint, Cerner, directory assistance, and credit reports to maximize collection efforts.
• Processes inbound and outbound calls professionally, providing exceptional customer service while resolving outstanding balances.
• Ensures proper application of account dispositions and follows self-pay policies and procedures.
• Adheres to all local, state, and federal laws and regulations, including FDCPA, TCPA, FCRA, CFPB, PCI, UDAAP, and HIPAA compliance standards.
• Performs other duties as assigned.
• Complies with all policies and standards.
  
  

Qualifications

• H.S. Diploma or GED required
• Associate Degree in Business, Finance, Healthcare Administration, or a related field preferred
• 0-2 years of experience in medical collections, accounts receivable, billing, or healthcare revenue cycle operations required
• Experience working with insurance follow-up, claim resolution, and payer communication in a healthcare setting preferred
  
  

Knowledge, Skills And Abilities

• Strong understanding of medical collections processes, payer reimbursement policies, and insurance claim resolution.
• Proficiency in electronic medical record (EMR) systems, patient accounting systems, and collections software.
• Knowledge of insurance contracts, denials management, and accounts receivable workflows.
• Excellent problem-solving and analytical skills to research and resolve outstanding claims.
• Effective verbal and written communication skills to interact with insurance payers, patients, and internal teams.
• Strong attention to detail with the ability to document account activity accurately.
• Ability to work independently in a fast-paced environment while meeting productivity and quality standards.
• Knowledge of regulatory compliance, including HIPAA, FDCPA, and applicable healthcare finance laws.

Seniority level

• Seniority level

  Entry level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Accounting/Auditing and Finance

• Industries

  Hospitals and Health Care

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