Collections Specialist II

Job Summary

The Collections Specialist II is responsible for managing outstanding patient accounts, ensuring accurate and timely collections from insurance companies, third-party payers, and self-pay patients. This role requires strong knowledge of insurance processes, medical billing, and collection regulations to maximize reimbursement and minimize bad debt. The Collections Specialist II works independently to research accounts, resolve payment discrepancies, and negotiate payment arrangements while maintaining compliance with federal, state, and organizational guidelines.

Essential Functions

• Manages assigned inventory of outstanding patient accounts, following up on insurance, third-party, and self-pay balances to ensure timely payment collection.
• Reviews and analyzes patient accounts, identifying alternative payment options, including insurance coverage, financial assistance programs, or legal action when necessary.
• Communicates with patients, guarantors, and insurance representatives via phone, email, and written correspondence to secure outstanding balances.
• Understands and explains the litigation process and its requirements, providing guidance on legal collections procedures when applicable.
• Resolves claim denials and payment discrepancies, working with payers and internal revenue cycle teams to ensure accurate reimbursement.
• Demonstrates knowledge of third-party collections regulations, utilizing automated resources and payer collection guidelines.
• Handles inbound and outbound collection calls professionally, ensuring courteous and compliant communication with all stakeholders.
• Accurately updates and maintains patient account records, documenting all actions taken in the system for compliance and audit purposes.
• Abides by all local, state, and federal collection laws, including HIPAA, FDCPA, TCPA, and CFPB regulations.
• Performs other duties as assigned.
• Complies with all policies and standards.

Qualifications

• H.S. Diploma or GED required
• 2-4 years of experience in medical billing, collections, accounts receivable, or insurance follow-up required
• Experience in hospital revenue cycle, third-party collections, or litigation-related collections preferred

Knowledge, Skills and Abilities

• Strong knowledge of insurance billing, reimbursement processes, and collection regulations.
• Familiarity with third-party payer requirements, claim denial management, and payment posting procedures.
• Ability to interpret and explain patient financial responsibilities, payment options, and litigation processes.
• Strong communication and negotiation skills, ensuring positive patient interactions and effective payer negotiations.
• Proficiency in healthcare billing software, electronic health records (EHR), and collections management systems.
• Knowledge of federal, state, and industry regulations related to collections, including HIPAA, FDCPA, and consumer protection laws.
• Strong problem-solving skills, with the ability to analyze account details, resolve billing disputes, and secure payments.