Revenue Cycle Collections Specialist

Overview

Revenue Cycle Collections Specialist role focused on improving third-party collections, reducing accounts receivable aging, and ensuring accurate claim adjudication and reimbursement.

Location: West Plano / Addison, TX area

Work Schedule: Onsite in-office with possible transition to hybrid based on individual performance

Reports to: Revenue Cycle Management Manager

Position Summary

This role is responsible for timely follow-up on third-party claims and patient balances, resolving denials, correcting posting errors, processing adjustments and write-offs, and managing payer correspondence. The position requires regular communication with commercial, Medicaid, and managed care payers, along with close collaboration with revenue cycle leadership and internal departments.

Key Duties

• Analyze claim payments to ensure reimbursement aligns with applicable state fee schedules.
• Follow up with insurance carriers by phone to confirm claim receipt and prompt reimbursement.
• Investigate and resolve payer claim issues, including resubmissions and claim adjustments.
• Monitor submitted claims to ensure timely payment and escalate unresolved issues as needed.
• Apply payments accurately, identify bad debt write-offs, and process A/R adjustments per policy.
• Detect and resolve duplicate payments or overpayments.
• Collect missing patient or insurance information from internal departments.
• Maintain HIPAA compliance and follow all federal, state, and payer guidelines.
• Verify billing accounts against the A/R ledger and document all interactions in the EHR.
• Address denial issues within three days of receipt.
• Submit medical records and supporting documentation for necessity reviews, denials, and appeals.
• Submit secondary claims promptly after primary remittance.
• Work to reduce third-party A/R and improve days sales outstanding (DSO).
• Use EMR and billing systems effectively.