Medicare & Medicaid Claims & Collections Pro

X Ray associates of New Mexico; Albuquerque (NM); On-site; USD 42,000 - 62,000; Full time

Job summary

X Ray associates of New Mexico is seeking a Medical Claims/Collections Billing Specialist to manage medical A/R queues, research insurance claim issues, and pursue timely reimbursement across Medicare, Medicaid, and commercial payers.

The role emphasizes Medicare/Medicaid billing knowledge, payer requirements, and strong problem-solving to reduce outstanding balances while maintaining HIPAA and patient confidentiality.

Qualifications

• High School Diploma or equivalent required.
• Minimum of 2 years of experience in medical accounts receivable, healthcare collections, insurance claims processing, or medical billing.
• Strong working knowledge of Medicare and Medicaid billing, claims processing, reimbursement, and collection procedures.

Responsibilities

• Manage and work assigned medical collection and A/R queues, prioritizing outstanding, aging, denied, and underpaid claims.
• Perform detailed follow-up on Medicare, Medicaid, and commercial insurance claims to identify payment delays, denials, underpayments, and outstanding balances.
• Review and interpret EOBs, ERAs, payer correspondence, and claim status information to determine appropriate collection and follow-up actions.
• Research claim denials, rejections, payment discrepancies, eligibility issues, authorization requirements, coding issues, and other barriers to reimbursement.
• Identify the reason a claim was not paid and take appropriate action, including correcting and resubmitting claims, contacting insurance carriers, submitting documentation, and initiating appeals when appropriate.
• Conduct timely and persistent insurance collections and A/R follow-up to maximize reimbursement and reduce outstanding balances.
• Utilize payer portals and internal systems to verify claim status, eligibility, benefits, payment information, and outstanding balances.
• Maintain thorough and accurate account documentation, MR notes, status codes, collection activity, and follow-up dates.
• Research exception reports and unresolved accounts and communicate findings and recommended actions to the Revenue Cycle Manager.
• Update patient demographic, insurance, and claim information in internal and external systems to ensure accurate billing and collections.
• Process corrected claims and other billing transactions through applicable billing systems.
• Assist patients with billing questions, account balances, insurance questions, and payment arrangements while providing professional and courteous customer service.
• Process patient payments accurately using the Z-Pay application.
• Identify trends in denials, unpaid claims, and payer issues and communicate recurring problems to management.
• Assist with training staff on Medicare, Medicaid, insurance requirements, collections procedures, claim follow-up, and billing workflows as needed.
• Maintain confidentiality and comply with HIPAA requirements and protection of PHI at all times.

Skills

Medical A/R

HIPAA compliance

Insurance claims processing

Medicare/Medicaid billing

Customer service

Billing software familiarity

Education

High School Diploma

Certification in medical billing

Tools

Z-Pay

RIS systems

Payer portals

Job description

X Ray associates of New Mexico is seeking a Medical Claims/Collections Billing Specialist to manage medical A/R queues, research insurance claim issues, and pursue timely reimbursement across Medicare, Medicaid, and commercial payers.

The role emphasizes Medicare/Medicaid billing knowledge, payer requirements, and strong problem-solving to reduce outstanding balances while maintaining HIPAA and patient confidentiality.