Health Claims Collections Specialist

Job Summary

To support a dynamic revenue cycle management team, the full-time Health Claims Collections Specialist II will resolve complex post-payment and denied DME claims, manage escalated accounts, and drive payer compliance while working remotely.

Key responsibilities

• Independently manage a portfolio of high-priority and complex claims requiring advanced solutions and strategies
• Analyze denials, overpayments, and underpayments to determine root causes and execute appropriate action plans, including appeals and payer outreach
• Research payer contract language and policy updates to apply findings to claims resolution and communicate relevant changes to peers and leadership

Required qualifications

• High School Diploma or Equivalent Experience
• Minimum 2+ years of medical collection or revenue cycle experience with emphasis on post-billing DME or orthopedic claims
• Advanced knowledge of payer guidelines, revenue cycle management, and appeals processes
• Strong working knowledge of ICD-10, HCPCs, and billing procedures for CMS-1500 claim forms
• Proficient in Microsoft Office and medical billing platforms