Remote Medical Collections Specialist – Medicare & Medicaid Claims Recovery Expert for Revenue Cycle Management (Work‑From‑Home)

About Our Vision‑Driven Healthcare Revenue Team

Join a purpose‑driven organization that is reshaping the financial health of medical providers nationwide. At the forefront of the healthcare industry, we partner with hospitals, physician groups, and specialty clinics to ensure that the vital services they deliver are reimbursed accurately and promptly. Our Revenue Cycle Management (RCM) division harnesses cutting‑edge technology, data analytics, and deep payer expertise to turn complex billing challenges into sustainable revenue streams. As a Remote Medical Collections Specialist, you will become an integral part of this mission, helping our clients navigate the intricate world of Medicare, Medicaid, and commercial insurance claims.

Why This Role Matters

Every day, healthcare providers face denied or underpaid claims that threaten their ability to deliver quality care. The Medical Collections Specialist acts as the front‑line advocate, turning denial letters into payment confirmations. Your expertise will:

• Accelerate cash flow for providers, allowing them to invest in new equipment, staff, and patient services.
• Protect the financial integrity of healthcare organizations by reducing write‑offs and bad debt.
• Enhance patient satisfaction by minimizing billing errors that could lead to unexpected out‑of‑pocket costs.
• Contribute to a culture of compliance, accuracy, and continuous improvement within our RCM team.

Position Overview

Job Title: Remote Medical Collections Specialist – Medicare & Medicaid Claims Recovery Expert
Department: Revenue Cycle Management
Location: Fully remote (work from home)
Employment Type: Full‑time, eligible for overtime as applicable
Compensation: $22.00 – $34.00 per hour, commensurate with experience, plus performance incentives and comprehensive benefits.

Core Objective

The primary objective of this role is to **identify, research, and resolve underpaid or denied claims** submitted to Medicare, Medicaid, and commercial payers. Leveraging detailed knowledge of payer requirements, coding standards, and appeals processes, you will ensure that each claim is revisited, corrected, and re‑submitted for full reimbursement. The specialist will also collaborate closely with billing, authorization, and benefits teams to pinpoint and remediate front‑end billing errors that contribute to claim denials.

Key Responsibilities

• Claim Follow‑Up & Communication: Initiate and maintain timely follow‑up on outstanding claims via payer portals, secure email, and telephone outreach, documenting each interaction with precision.
• Denial Analysis & Root Cause Identification: Examine Explanation of Benefits (EOB) statements, denial reason codes, and claim data to uncover the underlying causes of each denial, tracking patterns across payers and provider sites.
• Reconsideration & Appeal Management: Prepare, submit, and track denial reconsiderations and formal appeals, ensuring compliance with payer guidelines and including thorough supporting documentation.
• Front‑End Error Detection: Partner with billing and authorization teams to verify claim accuracy before submission, identifying missing authorizations, incorrect modifiers, or coding discrepancies that could trigger denials.
• Production & Quality Targets: Meet or exceed daily, weekly, and monthly claim resolution targets while maintaining high levels of accuracy, documentation integrity, and adherence to compliance standards.
• Trend Reporting: Generate regular reports that highlight denial trends, payer performance, and opportunities for process improvement, presenting findings to RCM leadership.
• Continuous Learning & Process Optimization: Stay current on updates to CPT, HCPCS, ICD‑10, and payer policies; actively propose workflow enhancements to reduce future denials.
• Team Collaboration: Work closely with the RCM Supervisor and Manager, sharing insights, assisting teammates with complex cases, and contributing to a supportive, high‑performance culture.
• Additional Duties: Perform any other duties assigned by supervisors that support the overall success of the revenue cycle function.

Essential Qualifications (Must‑Have)

• Proficient understanding of CPT, HCPCS, and ICD‑10 coding and ability to apply these codes accurately to patient services.
• Demonstrated experience in medical claim denials, reconsiderations, and appeals, preferably within Medicare, Medicaid, and commercial payer environments.
• Strong grasp of payer-specific requirements, reimbursement methodologies, and policy nuances.
• Hands‑on experience with medical billing software platforms (e.g., Epic, Cerner, MediTouch, or similar) and payer portals.
• Ability to read and interpret Explanation of Benefits (EOB) statements, denial reason codes, and claim statuses.
• Excellent written and verbal communication skills, with an emphasis on clear, concise, and professional correspondence.
• Critical thinking and problem‑solving capabilities, enabling rapid evaluation of options and efficient decision‑making.
• Demonstrated accountability, willingness to receive coaching, and a collaborative team‑oriented mindset.
• High‑speed internet connection, a reliable computer, and a private, distraction‑free workspace for remote work.

Preferred Qualifications (Nice‑to‑Have)

• Experience in infusion pharmacy billing or related high‑complexity reimbursement environments.
• Prior exposure to Revenue Cycle Management analytics tools (e.g., Power BI, Tableau) for trend analysis.
• Certification such as Certified Revenue Cycle Representative (CRCR) or Certified Professional Coder (CPC).
• Familiarity with compliance standards such as HIPAA, HITECH, and OIG guidelines.
• Multilingual abilities, particularly Spanish, to aid communication with diverse patient populations and payer representatives.

Core Skills & Competencies for Success

• Attention to Detail: Meticulous review of claim data, coding, and documentation to avoid errors.
• Analytical Mindset: Ability to dissect denial patterns, spot systemic issues, and propose data‑driven solutions.
• Resilience & Persistence: Tenacious follow‑up with payers, often requiring multiple contacts and creative problem‑solving.
• Customer‑Service Orientation: Professional, courteous communication with internal stakeholders and external payer representatives.
• Time Management: Prioritize high‑volume workloads while meeting strict production deadlines.
• Technology Proficiency: Comfortable navigating multiple software platforms, spreadsheets, and electronic health record (EHR) systems.
• Team Collaboration: Share knowledge, assist peers, and contribute to a culture of continuous improvement.

Career Growth & Learning Opportunities

Our organization believes that employee development fuels company success. As a Remote Medical Collections Specialist, you will have access to:

• Structured Mentorship Programs: Pairing with senior RCM leaders to accelerate your expertise.
• Professional Certifications: Company‑sponsored exam fees and study materials for CRCR, CPC, or similar credentials.
• Cross‑Functional Rotations: Opportunities to shadow billing, compliance, and analytics teams, broadening your revenue cycle perspective.
• Continuous Education: Monthly webinars on payer policy changes, coding updates, and emerging best practices.
• Career Pathways: Clear advancement routes to roles such as Senior Collections Analyst, RCM Team Lead, or Revenue Cycle Manager.

Work Environment & Company Culture

Even though this position is remote, you will be woven into a vibrant, inclusive culture that values:

• Flexibility: Choose work hours that align with personal productivity peaks while meeting core coverage windows for payer interactions.
• Transparency: Regular virtual town‑halls, performance dashboards, and open‑door communication with leadership.
• Collaboration: Virtual “coffee chats,” team huddles, and collaborative platforms (e.g., Microsoft Teams, Slack) that keep you connected.
• Well‑Being: Access to mental‑health resources, ergonomic home‑office stipends, and wellness challenges.
• Diversity & Inclusion: A commitment to building a workforce that reflects the communities we serve, with employee resource groups supporting underrepresented voices.

Compensation, Perks & Benefits

We recognize that rewarding talent goes beyond base pay. In addition to a competitive hourly rate ($22–$34) based on experience, you will receive:

• Performance Bonuses: Quarterly incentives tied to collections metrics and quality benchmarks.
• Comprehensive Health Benefits: Medical, dental, vision, and prescription coverage, with flexible spending accounts (FSAs) and health savings accounts (HSAs).
• Retirement Savings: 401(k) plan with company match to help you build long‑term financial security.
• Paid Time Off (PTO): Generous vacation, sick leave, and paid holidays to promote work‑life balance.
• Professional Development Stipend: Annual allocation for courses, conferences, or certification exams.
• Technology Allowance: Support for high‑speed internet, headset, and ergonomic office accessories.
• Employee Assistance Program (EAP): Confidential counseling, legal resources, and financial planning support.

How to Apply

If you are a motivated, detail‑oriented professional ready to make a tangible impact on the financial health of healthcare providers, we invite you to submit your application today. Please include a tailored resume highlighting your experience with claim denials, appeals, and coding, as well as a brief cover letter describing why you are the perfect fit for this remote role.

Ready to Take the Next Step?

Click the link below to begin your application journey. We look forward to learning how your expertise will strengthen our revenue cycle team and help us deliver exceptional financial outcomes for our partners.

Apply Now – Remote Medical Collections Specialist Position

Closing Statement

At our organization, every denied claim is an opportunity to demonstrate perseverance, expertise, and a commitment to the health of our clients’ bottom line. By joining us as a Remote Medical Collections Specialist, you become part of a forward‑thinking team that celebrates successes, learns from challenges, and consistently pushes the boundaries of revenue cycle excellence. Let’s turn obstacles into revenue together—apply now and embark on a rewarding career path that blends professional growth with meaningful impact.