Health Claims Collections Specialist

Job Summary

Resolving complex post-payment and denied DME claims, the full-time Health Claims Collections Specialist will manage high-priority accounts, conduct payer trend analysis, and assist in driving revenue recovery while working remotely.

Key responsibilities

• Independently manage a portfolio of complex claims requiring advanced solutions and strategies
• Analyze denials and execute action plans, including appeals and payer outreach
• Identify payer trends and escalate issues with supporting data to leadership

Required qualifications

• High School Diploma or Equivalent Experience
• Minimum 2+ years of medical collection or revenue cycle experience, specifically with DME or orthopedic claims
• Advanced knowledge of payer guidelines and appeals processes
• Proficiency in reading and interpreting EOBs and payer policies
• Strong working knowledge of ICD-10, HCPCs, and CMS-1500 billing procedures