US Healthcare Claims Collection Specialist

Role and Responsibilities

Contract Review & Payment Disputes

• Read and analyze contracts for payment disputes.
• Verify claim status with insurance providers and collect unpaid claims.
• Process claims payments, manage denials, and track claim statuses.

Provider-Side Operations

• Work directly on the provider (hospital) side for accounts receivable and collections.
• Interact with customers to ensure invoice accuracy and resolve claims discrepancies.
• Provide input on policies, systems, methods, and procedures for premium collection management.

Collections & Account Management

• Manage collections for healthcare unpaid claims.
• Monitor outstanding balances and ensure clients pay as billed.
• Prepare invoices and reconcile billing with accounts receivables.

Process Improvement & Compliance

• Conduct quality assurance and audits of collection activities.
• Handle documents, emails, and calls related to account processes.
• Educate customers on online applications for claims and payments.

Accounts Receivable Operations

• Perform follow-up, denial management, claims payment processing, tracking, and appeals for hospital processes.