Collections Specialist

We are seeking approximately three experienced Healthcare Billing & Collections Specialists to manage and recover outstanding healthcare payments. The ideal candidates will have experience handling unpaid and underpaid claims, communicating with insurance carriers, investigating payment discrepancies, and managing their own portfolio of accounts.

Experience in pharmacy billing, Workers’ Compensation, Personal Injury (PI), medical liens, or healthcare revenue cycle management is highly preferred. Candidates must be analytical, persistent, organized, and comfortable working independently in a results-driven environment.

Key Responsibilities

• Manage an assigned portfolio of healthcare accounts and outstanding claims.

• Follow up consistently on unpaid, underpaid, and denied insurance claims to secure payment.

• Contact insurance carriers, adjusters, and other relevant parties to investigate claim status and resolve outstanding balances.

• Analyze Explanation of Benefits (EOBs), reimbursement rules, fee schedules, denials, and payment discrepancies.

• Identify reasons for nonpayment, determine the appropriate resolution, and take the necessary steps to recover outstanding funds.

• Prepare and submit appeals, corrected claims, and supporting documentation when required.

• Negotiate with insurance carriers and adjusters to resolve payment disputes and maximize reimbursement.

• Maintain accurate account records, document collection activities, and track claim progress.

• Monitor collection performance, meet established targets, and ensure timely follow-up on assigned accounts.

• Apply knowledge of pharmaceutical terminology, medications, prescriptions, and pharmacy-related billing processes when applicable.

Requirements:

• Minimum of 1–2 years of experience in healthcare billing, medical collections, insurance claims follow-up, or revenue cycle management.

• Proven experience working with unpaid, underpaid, or denied claims.

• Ability to independently manage a portfolio of accounts and prioritize collection activities.

• Experience communicating and negotiating with insurance carriers, adjusters, or claims representatives.

• Knowledge of EOBs, reimbursement policies, fee schedules, appeals, denials, and payment reconciliation.

• Pharmacy billing experience is highly desirable. Candidates without direct pharmacy experience must demonstrate the ability to learn pharmaceutical terminology and understand medication- and prescription-related processes.

• Strong analytical, investigative, and problem-solving skills.

• Excellent English communication skills, ideally C1 level or near-native proficiency, with confidence handling professional phone calls.

• Strong organizational skills, attention to detail, persistence, and accountability.

• Ability to work independently in a performance-driven environment and meet collection goals.