Medical Collections Specialist

Overview

At SCP Health, you will be part of a team that connects hospitals and healers to improve clinical effectiveness across more than 8 million patients, 7,500 providers, 30 states, and 400 facilities. The role focuses on the entire revenue cycle for emergency medicine and hospital medicine services.

• Review accounts receivable (AR) by payer daily to meet reimbursement goals and days in AR.
• Prepare and submit timely appeals to overturn medical necessity denials and other claim denials.
• Provide regular feedback on payer/facility adjudication trends and behavior.
• Identify root causes of non‑payment and resolve claim denial issues, including coding, documentation, and compliance discrepancies.
• Maintain high productivity and quality, achieving a minimum 95% score on all quality assurance audits.
• Collaborate with coding specialists to address denial issues related to ICD‑9, ICD‑10, CPT, and HCPCS coding.
• Stay current on insurance policies, guidelines, and industry changes affecting emergency room and hospital medicine services.
• Collaborate with the medical billing team to implement preventive measures and provide training on denial prevention and resolution.
• Meet production standards and maintain detailed documentation for all appeals.

• Understanding of the overall revenue cycle process through final account adjudication.
• Excellent written and oral communication skills.
• Strong interpersonal, organizational, and problem‑solving abilities.
• Ability to work effectively in a team environment with a professional attitude and demeanor.
• Initiative‑taking and proactive approach to resolving issues.

• High School diploma or equivalent.

• At least 2 years of experience in medical insurance denial management for professional emergency room and hospital medicine services.
• Experience in customer service and patient billing within the medical industry.
• Ability to read and interpret Explanation of Benefits (EOBs) for government, commercial, PPO, HMO/IPA, and workers’ compensation payers.
• Intermediate knowledge of MS Office, including Excel and Word; 10‑key by touch proficiency.
• Familiarity with ICD‑9, ICD‑10, CPT, HCPCS coding, and general claims processing practices.
• Experience with electronic health records and billing systems such as OnBase, Centricity, Way Star, and payer portals is an advantage.

The role is performed in a professional office setting with continuous sitting and computer use. Occasional bending, kneeling, lifting, pulling, and pushing up to ten pounds are required. The position demands a high level of mental awareness and confidentiality.

All daily activities require strict confidentiality regarding individuals and strategic initiatives. Confidentiality must be maintained for all processed documents and information.

All employees must adhere to company policies and the Corporate Compliance Program, and comply with applicable local, state, and federal laws.

• Pay Range: 18.00 – 26.00 USD per hour (base salary; determined by experience and qualifications).
• Comprehensive benefits package including medical, dental, vision, 401(k) with company match, paid time off, holidays, professional development support, and wellness resources.