Job Summary
The Collections Specialist I 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.
As a Collections Specialist I at Community Health Systems (CHS) – SSC Sarasota, you’ll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical insurance, dental insurance, vision insurance, PTO, 401K, sick time, holidays, and bonus where eligible.
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.
- Complies with all policies and standards.
Qualifications
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Required:
- Education: H.S. Diploma or GED
- Experience: 0-2 years of experience in medical collections, accounts receivable, billing, or healthcare revenue cycle operations
- Preferred:
- Education: Associate’s Degree in Business, Finance, Healthcare Administration, or a related field
- Experience: Experience working with insurance follow-up, claim resolution, and payer communication in a healthcare setting
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.
We know it’s not just about finding a job. It’s about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.
The Sarasota SSC operates in support of our hospitals and patients and our commitment is to provide them with exemplary revenue cycle services defined by outstanding customer service and superior revenue cycle performance. SSC Sarasota support facilities located primarily in Florida, Georgia, Indiana, and Pennsylvania.
Community Health Systems is one of the nation’s leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.
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