Role OverviewThis position focuses on managing the end-to-end lifecycle of third-party payor accounts, from initial adjudication to final resolution. The specialist ensures accurate and compliant collections practices while maintaining clear communication with insurance providers, patients, and internal teams.
Key Responsibilities
- Conduct detailed reviews of patient accounts to identify potential issues and determine effective collection strategies.
- Engage with insurers, government agencies, and patients to resolve reimbursement discrepancies and accelerate payment cycles.
- Follow Fair Debt Collection Practices Act standards while pursuing outstanding balances in a professional and compliant manner.
- Maintain accurate records of high-value accounts, unresolved claims, and recurring reimbursement problems for reporting and analysis.
- Deposit payments securely and in a timely fashion when required.
- Report critical billing or reimbursement concerns to supervisory staff promptly.
- Support team collaboration within the accounts receivable unit and assist colleagues as directed.
- Participate in mandatory compliance training and uphold regulatory standards within daily workflows.
- Use strong problem-solving abilities to identify inefficiencies in billing and collections processes and recommend improvements.
- Interact professionally with diverse stakeholders to ensure smooth financial and insurance data exchange.
Required Qualifications
- High school diploma or equivalent education.
- 3–5 years of experience in accounts receivable or a comparable blend of education and hands-on experience.
- Proven ability to communicate effectively via phone, email, and in person with patients, payors, and government offices.
- Familiarity with Medicare, Medicaid, commercial insurers, and other third-party reimbursement systems.
- Proficiency with automated billing platforms, Word, and Excel.
- Strong organizational and time management skills to manage a high-volume workload.
- Excellent grammar, written communication, and customer service abilities aligned with organizational standards.
- Capacity to work independently, make sound decisions, and take initiative in resolving account issues.
- Completion of all required orientation and competency programs.
Preferred Qualifications
- Associate degree in Business or Healthcare Administration, or two years of secretarial experience.
- Background in medical terminology, ICD-9, or CPT coding.
- Experience operating office equipment such as copiers, fax machines, and mailing systems.
