Remote Medical Collections Specialist - Medicaid

Community Health Systems, Inc.; United States; Remote; USD 42,000 - 64,000; Full time

Benefits offered by this job

Paid Time Off

Comprehensive Health Benefits -Medical

401k with company match

Tuition reimbursement

Job summary

Community Health Systems, Inc. is seeking a Remote Medical Collections Specialist to join our Shared Services Center.

You will process, review, and verify reimbursement claims, analyze accounts, and apply transaction codes to support accurate claims processing. You will collaborate with revenue cycle teams, monitor outstanding claims, resolve discrepancies, and ensure compliance with payer guidelines and HIPAA.

Qualifications

• Knowledge of medical billing and reimbursement procedures.
• Familiarity with payer policies and claim adjudication.
• Experience with claims processing and denial management.
• Understanding HIPAA and healthcare compliance standards.

Responsibilities

• Process and verify reimbursement claims in compliance with payer guidelines.
• Review and resolve claim discrepancies, denials, or underpayments.
• Apply correct transaction codes to ensure proper adjudication and reimbursement flow.
• Monitor outstanding claims and follow up to ensure timely payment.
• Collaborate with revenue cycle teams and payers to manage denials and appeals.

Skills

Medical billing knowledge

Payer guidelines familiarity

Claims processing

Denial management

HIPAA compliance

Analytical thinking

Education

HS Diploma or GED

Associate Degree or related coursework

Tools

EHR systems

Billing software

Job description

As a Remote Medical Collections Specialist at Community Health Systems (CHS) - Shared Services Center, you’ll play a vital role in quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve.

Our Team Members Enjoy a Robust Benefits Package Including

• Paid Time Off (PTO)
• Comprehensive Health Benefits - Medical, Dental & Vision
• 401k with company match
• Tuition reimbursement

The Remote Collections Specialist is responsible for processing, reviewing, and verifying reimbursement claims to ensure accuracy, compliance, and timely resolution. This role involves analyzing account balances, identifying discrepancies, and applying appropriate transaction codes to facilitate accurate claims processing. The Reimbursement Specialist I collaborates with internal teams to support workflow efficiency, revenue integrity, and compliance with payer guidelines while maintaining productivity and accuracy standards.

• Processes and verifies reimbursement claims, ensuring accuracy and compliance with payer guidelines and regulatory requirements.
• Reviews and resolves claim discrepancies, identifying incorrect payments, denials, or underpayments and taking appropriate action.
• Applies correct transaction codes to accounts, ensuring proper claim adjudication and reimbursement flow.
• Monitors and follows up on outstanding claims, ensuring timely resolution and payment collection.
• Collaborates with revenue cycle teams and payers to investigate claim denials and appeal decisions when necessary.
• Researches and interprets payer policies, ensuring adherence to reimbursement requirements and claim submission rules.
• Documents account actions accurately and thoroughly in the appropriate systems, maintaining compliance with department protocols.
• Identifies process improvement opportunities, contributing to increased efficiency and streamlined reimbursement workflows.
• Maintains strict confidentiality of patient and financial information, ensuring compliance with HIPAA and corporate policies.
• Performs other duties as assigned.
• Complies with all policies and standards.
• This is a fully remote opportunity.

Qualifications

• H.S. Diploma or GED required
• Associate Degree or coursework in Accounting, Finance, Healthcare Administration, or related field preferred
• 0-1 years of experience in medical billing, reimbursement, claims processing, or accounts receivable required
• Experience with payer reimbursement policies, claim adjudication, and healthcare revenue cycle operations preferred

Knowledge, Skills And Abilities

• Strong knowledge of medical billing, reimbursement procedures, and payer guidelines.
• Familiarity with claim submission, denial management, and appeals processes.
• Ability to analyze account balances, identify discrepancies, and apply appropriate adjustments.
• Proficiency in electronic health records (EHR), billing software, and reimbursement systems.
• Strong problem-solving and critical-thinking skills, ensuring accurate claims resolution.
• Effective communication and collaboration skills, working with payers, revenue cycle teams, and internal departments.
• Knowledge of HIPAA, compliance regulations, and healthcare reimbursement standards.

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.

Community Health Systems is one of the nation's leading healthcare providers. With healthcare delivery systems in 36 distinct markets across 14 states, CHS operates 69 affiliated hospitals with more than 10,000 beds and approximately 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, imaging centers, cancer centers, and ambulatory surgery centers.

This position is not eligible for immigration sponsorship now or in the future. Applicants must be authorized to work in the U.S. for any employer.