Collections Specialist I - HMO/PPO (REMOTE)

Shared Services Center - Nashville; United States; Teletrabalho; USD 42 000 - 54 000; Tempo integral

Vantagens oferecidas por esta oferta de emprego

Comprehensive health coverage

401(k) with matching

Student loan support

Educational tuition assistance

Competitive pay & full benefits

Resumo da oferta

The Shared Services Center - Nashville is seeking a Collections Specialist I to perform follow-up on outstanding insurance balances for HMO/PPO plans in a remote US-based role. You will communicate with payers, document all activity, and resolve issues per applicable regulations.

The ideal candidate has 0–2 years in medical collections or healthcare revenue cycle operations, with strong attention to detail and solid knowledge of payer policies.

Qualificações

• Knowledge of medical collections processes and payer reimbursement policies.
• Experience with insurance follow-up and claim resolution in healthcare.
• Understanding of HIPAA and other healthcare regulations.

Responsabilidades

• Follow up on outstanding insurance balances within required timeframes.
• Document actions taken on accounts in the system for traceability.
• Make outbound calls to insurance payers and manage payer communications.
• Handle incoming correspondence within five days and update records.
• Use EMR and billing systems to analyze accounts and maximize collections.
• Process inbound/outbound calls with a strong customer service focus.
• Apply account dispositions and follow self-pay policies and procedures.
• Maintain compliance with FDCPA, TCPA, FCRA, CFPB, PCI, UDAAP, HIPAA.

Conhecimentos

Medical collections knowledge

Payer communication

Regulatory compliance

Attention to detail

Communication skills

Formação académica

H.S. Diploma or GED

Ferramentas

EMR systems

Payer databases

Descrição da oferta de emprego

Collections Specialist I - HMO/PPO (REMOTE)

United States

Trending

Job Description

• Comprehensive Health Coverage – Medical, dental, and vision plans to keep you and your family healthy.
• Future Security: 401(k) with matching
• Student Loan Support – Up to $10,000 repayment assistance, because we invest in your future.
• Educational Tuition Assistance
• Competitive Pay & Full Benefits – A salary and package designed to reward your expertise and dedication.

Job Summary The Collections Specialist I - HMO/PPO 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.
• Maintains regular and reliable attendance.
• 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.

We know it’s not just about finding a job. It’s about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.

The Shared Services Center - Nashville provides business office support functions like billing, insurance follow-up, call center customer service, data entry and more for hospitals and healthcare providers. But we're not only about work. We know employing a skilled and engaged team of professionals is vitally important to our success, so we make sure to offer competitive benefits, recognition programs, professional development opportunities and a fun and engaging team environment.

Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.

Job Info

• Job Identification 166453
• Job Category Finance and Accounting
• Job Schedule Full time
• Job Shift Day
• Locations 4000 Meridian Blvd, Franklin, TN, 37067, US