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We are looking for a Medical Collections Specialist to join a healthcare team in Sacramento, California. This contract-to-permanent opportunity is ideal for someone who brings strong experience in insurance follow-up, denial resolution, and patient balance discussions within a high-volume revenue cycle environment. The role is onsite and focuses on reviewing claim outcomes, pursuing reimbursement, and helping ensure accounts are resolved accurately and efficiently.
Job Responsibility
Review payer contracts and reimbursement terms to determine correct allowed amounts and identify underpayments
Interpret Explanation of Benefits statements to evaluate claim decisions and confirm financial responsibility
Investigate denied, delayed, or partially paid claims and take appropriate action to secure proper reimbursement
Prepare clear, persuasive appeals that address payer findings and support claim reconsideration
Communicate with insurance carriers to resolve billing discrepancies, payment issues, and adjudication concerns
Speak with patients regarding outstanding balances, explaining how copays, deductibles, coinsurance, and out-of-pocket limits affect what they owe
Maintain consistent follow-up on assigned accounts while meeting productivity expectations in a fast-moving workload
Apply analytical judgment to determine the most effective next steps for account resolution and escalation when needed
Collaborate with team members to support collection goals and maintain quality standards across account follow-up activities
Requirements
Experience in medical collections, accounts receivable follow-up, or healthcare reimbursement functions
Strong understanding of Explanation of Benefits documents and insurance claim adjudication processes
Knowledge of patient financial responsibility concepts, including copays, deductibles, coinsurance, and out-of-pocket maximums
Familiarity with commercial insurance plans, PPO products, and Medicare Advantage reimbursement structures
Proven ability to write effective appeals for denied or underpaid medical claims
Confidence interacting with both insurance representatives and patients regarding account balances and claim outcomes
Ability to manage a high-volume workload, stay organized under pressure, and consistently achieve performance targets
Working knowledge of medical terminology and revenue cycle processes related to claim denials and reimbursement