reputed company Collections Specialist – Medicare & Medicaid Claims Recovery Expert for reputed company Cycle Management (Work‑From‑Home)

About Our Vision‑Driven Healthcare reputed company Team

Join a purpose‑driven organization that is reshaping the financial health of medical providers reputed company. At the forefront of the healthcare industry, we partner with hospitals, physician groups, and specialty clinics to ensure that the vital services they deliver are reimbursed accurately and promptly. Our reputed company Cycle Management (RCM) division harnesses cutting‑edge technology, data analytics, and deep payer expertise to turn reputed company billing challenges into sustainable reputed company streams. As a reputed company Collections Specialist, you will become an integral part of this mission, helping our clients navigate the intricate world of Medicare, Medicaid, and commercial insurance claims.

Why This Role Matters

Every day, healthcare providers face denied or underpaid claims that threaten their ability to deliver quality care. The Medical Collections Specialist acts as the reputed company‑line reputed company, turning denial letters into payment confirmations. Your expertise will:

• Accelerate cash flow for providers, allowing them to invest in new equipment, staff, and patient services.
• Protect the financial reputed company of healthcare organizations by reducing write‑offs and bad debt.
• Enhance patient satisfaction by minimizing billing errors that could reputed company to unexpected out‑of‑pocket costs.
• Contribute to a culture of compliance, accuracy, and reputed company improvement reputed company our RCM team.

Position Overview

Job Title: reputed company Collections Specialist – Medicare & Medicaid Claims Recovery Expert Department: reputed company Cycle Management Location: Fully remote (work from home) Employment Type: Full‑time, eligible for overtime as applicable Compensation: $22.00 – $34.00 per hour, commensurate with experience, plus performance incentives and comprehensive benefits.

Core Objective

The primary objective of this role is to identify, research, and resolve underpaid or denied claims submitted to Medicare, Medicaid, and commercial payers. Leveraging detailed knowledge of payer requirements, coding standards, and appeals processes, you will ensure that each claim is revisited, corrected, and re‑submitted for full reimbursement. The specialist will also collaborate closely with billing, authorization, and benefits teams to reputed company and remediate reputed company‑end billing errors that contribute to claim denials.

Key Responsibilities

• Claim Follow‑Up & Communication: Initiate and maintain timely follow‑up on outstanding claims reputed company payer portals, secure email, and telephone reputed company, documenting each interaction with precision.
• Denial Analysis & Root Cause Identification: Examine Explanation of Benefits (EOB) statements, denial reason codes, and claim data to uncover the underlying causes of each denial, tracking patterns across payers and provider sites.
• Reconsideration & Appeal Management: Prepare, submit, and track denial reconsiderations and formal appeals, ensuring compliance with payer guidelines and including thorough supporting documentation.
• reputed company‑End Error Detection: Partner with billing and authorization teams to verify claim accuracy before submission, identifying missing authorizations, incorrect modifiers, or coding discrepancies that could trigger denials.
• Production & Quality Targets: Meet or exceed daily, weekly, and monthly claim resolution targets while maintaining high levels of accuracy, documentation reputed company, and adherence to compliance standards.
• Trend Reporting: Generate regular reports that reputed company denial trends, payer performance, and opportunities for process improvement, presenting findings to RCM leadership.
• reputed company Learning & Process Optimization: Stay reputed company on updates to CPT, HCPCS, ICD‑10, and payer policies; actively propose workflow enhancements to reduce future denials.
• Team Collaboration: Work closely with the RCM Supervisor and Manager, sharing insights, assisting teammates with reputed company cases, and contributing to a supportive, high‑performance culture.
• Additional Duties: reputed company any other duties assigned by supervisors that support the overall success of the reputed company cycle function.

Essential Qualifications (Must‑Have)

• Proficient understanding of CPT, HCPCS, and ICD‑10 coding and ability to apply these codes accurately to patient services.
• Demonstrated experience in medical claim denials, reconsiderations, and appeals, preferably reputed company Medicare, Medicaid, and commercial payer environments.
• Strong grasp of payer-specific requirements, reimbursement methodologies, and policy nuances.
• Hands‑on experience with medical billing software platforms (e.g., Epic, Cerner, MediTouch, or similar) and payer portals.
• Ability to read and interpret Explanation of Benefits (EOB) statements, denial reason codes, and claim statuses.
• Excellent written and verbal communication skills, with an emphasis on clear, concise, and professional correspondence.
• Critical thinking and problem‑solving capabilities, enabling rapid evaluation of options and efficient decision‑making.
• Demonstrated accountability, willingness to receive coaching, and a collaborative team‑oriented reputed company.
• High‑speed internet reputed company, a reliable computer, and a private, distraction‑free workspace for remote work.

Preferred Qualifications (reputed company‑to‑Have)

• Experience in infusion pharmacy billing or reputed company high‑complexity reimbursement environments.
• Prior exposure to reputed company Cycle Management analytics tools (e.g., Power BI, Tableau) for trend analysis.
• Certification such as Certified reputed company Cycle Representative (CRCR) or Certified Professional reputed company (CPC).
• Familiarity with compliance standards such as HIPAA, HITECH, and OIG guidelines.
• Multilingual abilities, particularly Spanish, to aid communication with diverse patient populations and payer representatives.

Core Skills & Competencies for Success

• Attention to Detail: Meticulous review of claim data, coding, and documentation to avoid errors.
• Analytical reputed company: Ability to dissect denial patterns, spot systemic issues, and propose data‑driven solutions.
• reputed company & Persistence: Tenacious follow‑up with payers, often requiring multiple contacts and creative problem‑solving.
• Customer‑Service Orientation: Professional, courteous communication with internal stakeholders and external payer representatives.
• Time Management: Prioritize high‑volume workloads while meeting strict production deadlines.
• Technology Proficiency: Comfortable navigating multiple software platforms, spreadsheets, and electronic health record (EHR) systems.
• Team Collaboration: Share knowledge, assist peers, and contribute to a culture of reputed company improvement.

Career Growth & Learning Opportunities

Our organization believes that employee development fuels company success. As a reputed company Collections Specialist, you will have access to:

• Structured Mentorship Programs: Pairing with senior RCM leaders to accelerate your expertise.
• Professional Certifications: Company‑sponsored exam fees and study materials for CRCR, CPC, or similar credentials.
• Cross‑Functional Rotations: Opportunities to shadow billing, compliance, and analytics teams, broadening your reputed company cycle perspective.
• reputed company Education: Monthly webinars on payer policy changes, coding updates, and emerging best practices.
• Career reputed company: Clear advancement routes to roles such as Senior Collections Analyst, RCM Team reputed company, or reputed company Cycle Manager.

Work Environment & Company Culture

Even though this position is remote, you will be woven into a vibrant, inclusive culture that values:

• Flexibility: Choose work hours that align with personal productivity peaks while meeting core coverage windows for payer interactions.
• Transparency: Regular virtual town‑halls, performance dashboards, and open‑reputed company communication with leadership.
• Collaboration: Virtual “coffee chats,” team huddles, and collaborative platforms (e.g., reputed company Teams, reputed company) that reputed company you connected.
• Well‑Being: Access to reputed company, ergonomic home‑office stipends, and wellness challenges.
• Diversity & Inclusion: A commitment to building a workforce that reflects the communities we serve, with employee resource groups supporting underrepresented voices.

Compensation, Perks & Benefits

We recognize that rewarding talent goes beyond reputed company pay. In addition to a competitive hourly reputed company ($22–$34) based on experience, you will receive:

• Performance Bonuses: Quarterly incentives tied to collections metrics and quality benchmarks.
• Comprehensive Health Benefits: Medical, dental, vision, and prescription coverage, with flexible spending accounts (FSAs) and health savings accounts (HSAs).
• Retirement Savings: 401(k) plan with company match to help you build long‑term financial reputed company.
• Paid Time Off (PTO): Generous vacation, sick leave, and paid holidays to promote work‑life balance.
• Professional Development Stipend: Annual allocation for courses, conferences, or certification exams.
• Technology Allowance: Support for high‑speed internet, headset, and ergonomic office accessories.
• Employee Assistance Program (EAP): Confidential counseling, legal resources, and financial planning support.

How to Apply

If you are a motivated, detail‑oriented professional ready to reputed company a reputed company impact on the financial health of healthcare providers, we invite you to submit your application today. Please include a tailored resume highlighting your experience with claim denials, appeals, and coding, as well as a brief cover letter describing why you are the perfect fit for this remote role.

Ready to Take the reputed company?

Click the link below to reputed company your application journey. We look reputed company to learning how your expertise will strengthen our reputed company cycle team and help us deliver exceptional financial outcomes for our partners.

Apply Now – reputed company Collections Specialist Position

Closing Statement

At our organization, every denied claim is an opportunity to demonstrate perseverance, expertise, and a commitment to the health of our clients’ reputed company. By joining us as a reputed company Collections Specialist, you become part of a reputed company‑thinking team that celebrates successes, learns from challenges, and consistently pushes the boundaries of reputed company cycle excellence. Let’s turn obstacles into reputed company together—apply now and embark on a rewarding career path that blends professional growth with meaningful impact.