Medical Collections and Revenue Cycle Specialist

Job Summary

The Medical Collections and Revenue Cycle Specialist reporting to the Assistant Controller is responsible for maximizing cash flow through proactive management of all post-billing Accounts Receivable (AR) functions. This specialist will primarily focus on aggressive collections resolving complex claim denials and disputes and ensuring compliance using strong medical coding knowledge. This role is critical to maintaining a healthy cash flow and strong customer relationships.

Duties and Responsibilities

• Collections and Accounts Receivable Management: Take full ownership of the accounts receivable (AR) portfolio monitoring aging reports and driving collections of outstanding balances. Proactively follow up persistently with customers and payers on overdue invoices/claims via email phone and statements to secure timely reimbursements. Collaborate with leadership (Controller/Billing Lead) to reduce DSO and meet cash collection targets. Apply customer payments accurately and in a timely manner to open invoices. Reconcile customer accounts and follow up on short pays overpayments and unapplied funds. Identify chronic payment issues and work cross-functionally to improve collections processes.

• Claim Denial Management and Coding Compliance: Act as the primary point of contact for claim denials payment discrepancies and invoice disputes. Research analyze and resolve rejected denied or underpaid claims by communicating with payers and customers. Utilize strong working knowledge of CPT/ICD codes and EOBs to understand denial reasons and manage the appeal process. Handle resubmissions and adjustments of rejected or denied claims ensuring timely resolution and payment recovery. Document root causes of denials and implement corrective actions to reduce recurring errors. Ensure adherence to company policies customer contracts and regulatory requirements in all billing practices and claim appeals including HIPAA.
• Communication and Coordination: Investigate issues by coordinating with internal teams such as Scheduling Verification Customer Service and Operations to gather missing documentation for claim resolution. Correct and reissue invoices as necessary to ensure resolution and maintain positive client relationships. Communicate with customers and payers to clarify claim formats payment terms and invoice policies. Respond promptly to billing inquiries from clients and internal departments. Document all dispute resolutions and update system records accordingly.
• Reporting and Administration: Maintain up-to-date AR records and provide weekly aging and collections status reports to leadership. Prepare monthly and quarterly billing and reconciliation reports for customers and leadership. Identify gaps in billing collections and customer communication workflows and recommend improvements. Assist with bank reconciliations and month-end close processes. Support audit preparation and respond to inquiries related to AR and billing.

• 23 years of experience in accounts receivable medical collections or claims processing (healthcare industry preferred)
• Strong experience managing AR aging driving collections and resolving disputed claims/invoices
• Strong knowledge of CPT/ICD codes EOBs and healthcare claim workflows
• Proficiency in QuickBooks Online; familiarity with billing/collections platforms like Interpreter Intelligence YayPay or XTRF is a plus
• Excellent organizational analytical and strong written and verbal communication skills
• Ability to work independently and prioritize in a deadline-driven environment with high attention to detail and a customer service mindset

• Medical Dental and Vision Insurance
• 401(k) with company match
• Generous PTO and paid holidays
• Professional development opportunities
• Employee assistance program
• Company-sponsored events and activities
• Hybrid Work Environment
• Pay Range: $25-27/hour

Required Experience:

IC