Senior Medical Collections & Appeals Specialist – Houston

Strive Rehabilitation Partners; Houston (TX); On-site; USD 32,000 - 39,000; Full time

Job summary

Strive Rehabilitation Partners seeks an experienced Insurance Collections & Appeals Specialist to maximize reimbursement through proactive AR follow-up, denial resolution, and payer communication. This role requires navigating payer requirements and independently managing a portfolio of outstanding receivables in a Houston-based office.

The ideal candidate has 3+ years in medical insurance collections, strong knowledge of Medicare/ commercial billing, and proven ability to resolve complex claims

Qualifications

• Minimum 3 years of experience in medical insurance collections, AR follow-up, denial management, or appeals.
• Demonstrated experience resolving complex unpaid and denied medical insurance claims.
• Strong working knowledge of commercial insurance reimbursement and Medicare billing requirements.
• Experience with professional medical billing, CMS-1500, CPT codes, ICD-10, modifiers, and EOB analysis.
• Ability to interpret remittance advice, adjustment reason codes, and payer denial explanations.
• Experience preparing written appeals, reconsideration requests, or formal payer disputes.
• Proficiency with medical billing or practice management software and online payer portals.
• Strong organizational skills and ability to manage multiple accounts, deadlines, and follow-up priorities.
• Excellent written and verbal communication skills with insurance representatives.
• Ability to investigate problems independently and follow claims through to final resolution.
• Working knowledge of HIPAA requirements and confidential patient information handling.
• Ability to work full-time, on-site at our Houston office.

Responsibilities

• Manage assigned insurance accounts receivable balances, prioritizing aged, high-dollar, and at-risk claims.
• Follow up with Medicare, Medicare Advantage, Medicaid, and commercial payers.
• Investigate unpaid, partially paid, rejected, and underpaid claims to determine resolution.
• Research claim status, payment discrepancies, and reimbursement issues using payer portals and practice management systems.
• Identify and resolve claim processing errors, COB issues, authorization discrepancies, and payment barriers.
• Monitor timely filing deadlines, reconsideration windows, and appeal requirements.
• Maintain accurate documentation of collection activity and next steps.
• Escalate systemic reimbursement issues and high-risk accounts to management.

Skills

Analytical thinking

Persistent

Organizational skills

Communication skills

Independent problem solving

Tools

AdvancedMD

Waystar

Job description

Strive Rehabilitation Partners seeks an experienced Insurance Collections & Appeals Specialist to maximize reimbursement through proactive AR follow-up, denial resolution, and payer communication. This role requires navigating payer requirements and independently managing a portfolio of outstanding receivables in a Houston-based office.

The ideal candidate has 3+ years in medical insurance collections, strong knowledge of Medicare/ commercial billing, and proven ability to resolve complex claims