Medicare Managed Care Medical Collections Specialist

A hospital in Los Angeles is seeking a Medicare Managed Care Medical Collections Specialist to support its revenue cycle team. The Medicare Managed Care Medical Collections Specialist is responsible for follow-up on unpaid claims, insurance appeals, denial resolution, and insurance accounts receivable activities to help maximize reimbursement and reduce aging balances.

Key Responsibilities:

Call insurance companies, payers, and/or patients to secure payment on unpaid claims. Perform timely follow-up on outstanding insurance accounts receivable to ensure appropriate reimbursement. Manage and prioritize daily workload to maximize collection efforts and minimize delays in payment resolution. Submit and track insurance appeals related to denied or underpaid claims. Based on general knowledge.

Review denials, determine root cause, and take corrective action to support claim resolution. Gather and provide required documentation to payers to support payment or appeal requests. Work closely with internal departments to resolve billing discrepancies and improve claim turnaround times. Maintain accurate account notes and update billing systems with collection and follow-up activity. Monitor unpaid claims to ensure timely escalation and resolution.

Qualifications:

Previous experience in medical collections, insurance follow-up, or healthcare accounts receivable required. Experience with Medicare managed care collections in a hospital or healthcare setting preferred. Strong knowledge of insurance appeals, denial management, and insurance AR follow-up. Familiarity with medical billing processes, payer guidelines, and reimbursement practices. Strong communication, negotiation, and problem-solving skills. Ability to organize and prioritize a high-volume workload in a fast-paced environment. Proficiency with hospital billing systems and electronic medical or revenue cycle platforms preferred.