Collections Specialist I - HMO/PPO (REMOTE)

Tennova Healthcare- North Knoxville Medical Center; United States; On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

401(k) with matching

Student loan repayment up to $10,000

Tuition assistance

Health insurance

Job summary

Community Health Systems seeks a Collections Specialist I - HMO/PPO to follow up on outstanding insurance balances, identify claim issues, and ensure timely resolution in line with contract terms. This role requires effective payer communication and precise account documentation to support revenue cycle operations.

The position operates within the Shared Services Center - Nashville, focusing on HIPAA/FDCPA-compliant processes and high-quality customer service while supporting hospital network

Qualifications

• High school diploma or GED required.
• Associate degree in Finance, Healthcare Administration, or related field preferred.
• 0–2 years in medical collections or healthcare revenue cycle operations required.
• Experience with payer follow-up and claim resolution in a healthcare setting preferred.

Responsibilities

• Performs follow-up on outstanding insurance balances within required timeframes.
• Documents all account actions in the system for traceability.
• Makes outbound calls to insurance payers and communicates professionally.
• Handles and resolves incoming correspondence within five days of receipt.

Skills

Follow-up collections

Payer communication

Documentation accuracy

Regulatory compliance

Analytical skills

Communication skills

Independent work

Education

H.S. Diploma or GED

Associates degree preferred

Tools

EMR systems

Patient accounting systems

Collections software

AS400/Meditech

Job description

Benefits

• 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.