Hospital Medical Collections Specialist

A Hospital in the San Fernando Valley are looking for an experienced Hospital Medical Collections Specialist. The Hospital Medical Collections Specialist ideal for someone with a strong background in medical revenue cycle activities and a solid understanding of payer follow-up across government and commercial plans. The Hospital Medical Collections Specialist will help drive timely reimbursement by resolving outstanding accounts, addressing denials, and working through appeals for both inpatient and outpatient hospital claims. The hospital is open to candidates with at least 2 years of experience.

Responsibilities:

• Pursue payment on outstanding hospital accounts by conducting thorough follow-up with insurance carriers and other payers to secure accurate and timely reimbursement.
• Review inpatient and outpatient claims to identify billing issues, payment delays, denials, and underpayments, then take appropriate action to move accounts toward resolution.
• Manage collection activity across a range of payer types, including Medicare managed care, Medi-Cal managed care, commercial plans, and HMO or PPO coverage.
• Prepare and submit appeals, reconsiderations, and supporting documentation to challenge denied or incorrectly processed claims.
• Investigate account discrepancies by analyzing billing records, payer responses, and remittance details to determine the next steps for resolution.
• Coordinate with internal teams to correct claim information, resolve documentation gaps, and improve the collection of hospital receivables.
• Maintain detailed account notes and status updates to ensure clear documentation of collection efforts and payer communications.