Health Claims Collections Specialist II

Job Description

As a Health Claims Collections Specialist II, you'll manage a portfolio of complex, high-priority claims, crafting advanced solutions. Your responsibilities include analyzing denials, overpayments, and underpayments to pinpoint root causes, then executing action plans with appeals and payer outreach. You'll prepare technical and medical necessity appeals at all levels with supporting documentation, researching payer contracts and policy updates to inform claim resolution and peer communication. Identifying payer trends and resolving escalated issues related to audits and coordination of benefits will be crucial. Additionally, you will manage HCFA returns, ensure accurate account documentation across systems, and consistently exceed productivity metrics to maximize cash recovery.

Qualifications

1. Minimum of 2 years in medical collections or revenue cycle, specializing in post-billing DME or orthopedic claims. 2. Advanced knowledge of payer guidelines, revenue cycle management, and appeals processes (Medicare, Medicaid, and commercial insurance). 3. Expertise in interpreting EOBs, payer policies, LCDs, and prior authorization requirements. 4. Strong knowledge of ICD-10, HCPCs, and CMS-1500 claim forms. 5. Proficiency in Microsoft Office and medical billing platforms. 6. Proven experience in managing complex denials and appeals at all levels. 7. Detail-oriented with trend identification and corrective strategy implementation skills. 8. Excellent communication and negotiation abilities with payers and stakeholders. 9. Ability to work independently with a focus on accuracy and compliance. 10. Familiarity with Oracle or similar revenue cycle platforms.

Benefits

- Health insurance - Paid time off - Professional development