Remote Medical Collections Specialist – Denials & Appeals

Surgery Partners, Inc; Addison (TX); Hybrid; USD 42,000 - 66,000; Full time

Job summary

Surgery Partners, Inc. seeks a Medical Collection Specialist to ensure effective collection of patient accounts in a hybrid/remote role requiring reliable internet.

The successful candidate will have 3–5 years in medical billing/collections, EPIC experience preferred, and a strong background in insurance terminology and claim follow-ups. This position emphasizes accuracy, multitasking, and collaboration with payer representatives.

Qualifications

• High School Diploma
• 3–5 years in office billing and collections (CBO)
• Detail-oriented with strong accuracy
• Ability to prioritize work independently and multi-task
• Knowledge of insurance, billing terms, CPT/ICD10, coding and DRG
• Knowledge of modifiers usage and CCI edits
• Strong medical insurance background
• MS Office applications including Outlook, Word, Excel, and PowerPoint
• Critical thinking skills
• Spine/Orthopedic surgery experience preferred
• EPIC experience preferred
• Minimum of three years’ experience in medical collections
• Hospital Billing/Collections preferred

Responsibilities

• Perform extensive insurance claim follow-ups for denials and appeals.
• Interact with payer representatives, HIM, Insurance Verification and Access Service departments
• Participates in group meetings and/or various committees
• Ability to effectively present information regarding denial trends, and present to management
• Read, understand, interpret and resolve payer denials and EOBs
• Understanding of copays, coinsurance, deductibles, and denial codes
• Ensure denial reviews, claim follow-ups are conducted in a timely manner in accordance with payer timely filing limits
• Correct claims and file appeals with supporting documents to insurance companies, by phone, electronically or mail
• Ability to work receivables to investigate and resolve denials and partial payments
• Ability to calculate reimbursement per payer contract
• Maintains a positive attitude toward their position and responsibilities

Job description

Surgery Partners, Inc. seeks a Medical Collection Specialist to ensure effective collection of patient accounts in a hybrid/remote role requiring reliable internet.

The successful candidate will have 3–5 years in medical billing/collections, EPIC experience preferred, and a strong background in insurance terminology and claim follow-ups. This position emphasizes accuracy, multitasking, and collaboration with payer representatives.