Collections Specialist I - Medicaid

Collections Specialist I - Medicaid

The Collections Specialist I - Medicaid is responsible for performing collection follow-up on outstanding insurance balances, identifying claim issues, and ensuring timely resolution in compliance with government and managed care contract terms. This role requires effective communication with insurance payers, documentation of account activity, and adherence to applicable regulations to support revenue cycle operations.

Essential Functions

• Performs follow-up on outstanding insurance balances within the required timeframe, obtaining payment confirmation or required documentation.
• Documents all actions taken on accounts within the appropriate system, ensuring a clear and traceable resolution process.
• Makes the required number of outbound calls to insurance payers while maintaining professional and courteous communication.
• Handles and resolves incoming correspondence within five days of receipt, updating the system with relevant information.
• Analyzes assigned accounts using AS400, Meditech, Accurint, Cerner, directory assistance, and credit reports to maximize collection efforts.
• Processes inbound and outbound calls professionally, providing exceptional customer service while resolving outstanding balances.
• Ensures proper application of account dispositions and follows self-pay policies and procedures.
• Adheres to all local, state, and federal laws and regulations, including FDCPA, TCPA, FCRA, CFPB, PCI, UDAAP, and HIPAA compliance standards.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Qualifications

• H.S. Diploma or GED required
• Associate Degree in Business, Finance, Healthcare Administration, or a related field preferred
• 0-2 years of experience in medical collections, accounts receivable, billing, or healthcare revenue cycle operations required
• Experience working with insurance follow-up, claim resolution, and payer communication in a healthcare setting preferred

Knowledge, Skills And Abilities

• Strong understanding of medical collections processes, payer reimbursement policies, and insurance claim resolution.
• Proficiency in electronic medical record (EMR) systems, patient accounting systems, and collections software.
• Knowledge of insurance contracts, denials management, and accounts receivable workflows.
• Excellent problem-solving and analytical skills to research and resolve outstanding claims.
• Effective verbal and written communication skills to interact with insurance payers, patients, and internal teams.
• Strong attention to detail with the ability to document account activity accurately.
• Ability to work independently in a fast-paced environment while meeting productivity and quality standards.
• Knowledge of regulatory compliance, including HIPAA, FDCPA, and applicable healthcare finance laws.

Key skills/competency

• Medical Collections
• Medicaid
• Revenue Cycle
• Insurance Follow-up
• Claim Resolution
• HIPAA Compliance
• FDCPA
• EMR Systems
• Payer Communication
• Accounts Receivable