Collections & AR Specialist - Multi-Office Mental Health Practice

The Insurance Collections & Appeals Specialist is responsible for maximizing insurance reimbursement through proactive accounts receivable follow-up, denial resolution, appeals, and payer communication.

This position requires an experienced revenue cycle professional who understands medical insurance billing, can independently investigate complex reimbursement issues, and knows how to navigate payer requirements to secure payment.

The ideal candidate is analytical, persistent, organized, and comfortable challenging incorrect payer determinations. Experience with behavioral health billing, professional medical claims, and Medicare reimbursement is particularly valuable.

This is not an entry-level billing position. We are looking for someone who can independently manage a portfolio of outstanding receivables, identify barriers to payment, and consistently produce measurable collection results.

• Manage assigned insurance accounts receivable balances, prioritizing aged, high-dollar, and otherwise at-risk claims.
• Conduct proactive follow-up with Medicare, Medicare Advantage, Medicaid, and commercial insurance payers.
• Investigate unpaid, partially paid, rejected, and underpaid claims to determine the appropriate resolution.
• Research claim status, payment discrepancies, and reimbursement issues using payer portals, practice management systems, and direct payer communication.
• Identify and resolve claim processing errors, missing documentation, coordination-of-benefits issues, authorization discrepancies, and other payment barriers.
• Monitor timely filing deadlines, reconsideration windows, and appeal requirements to protect reimbursement opportunities.
• Maintain accurate documentation of collection activity, payer communications, and next steps.
• Escalate systemic reimbursement issues and high-risk accounts to management as appropriate.

• Analyze claim denials and identify the underlying causes of nonpayment.
• Prepare, submit, and track first-level and subsequent appeals, including supporting documentation and written medical reimbursement arguments.
• Challenge inappropriate denials, incorrect contractual adjustments, and reimbursement determinations inconsistent with payer requirements.
• Research payer medical policies, reimbursement guidelines, coverage requirements, and applicable Medicare regulations.
• Work with clinical and administrative personnel to obtain medical records and other documentation necessary to support appeals.
• Track appeal outcomes and follow through until claims are appropriately resolved.
• Identify recurring denial patterns and recommend corrective actions to prevent future revenue loss.

• Review aging reports, denial trends, collection performance, and payer-specific reimbursement issues.
• Identify opportunities to accelerate cash collections and reduce outstanding A/R.
• Collaborate with billing, credentialing, and clinical personnel to resolve issues affecting claim payment.
• Assist in identifying payer enrollment, provider credentialing, or contracting issues contributing to reimbursement delays.
• Recommend improvements to billing workflows, claim submission practices, and denial prevention processes.
• Provide regular updates on collection activity, unresolved accounts, appeal status, and recovery results.
• Support special projects involving aged receivables, payer reconciliations, and revenue recovery initiatives.

• Minimum 3 years of experience in medical insurance collections, accounts receivable follow-up, denial management, or appeals.
• Demonstrated experience resolving complex unpaid and denied medical insurance claims.
• Strong working knowledge of commercial insurance reimbursement and Medicare billing requirements.
• Experience with professional medical billing, including CMS-1500 claims, CPT codes, ICD-10 diagnosis codes, modifiers, and explanation-of-benefits analysis.
• Ability to interpret remittance advice, adjustment reason codes, and payer denial explanations.
• Experience preparing written appeals, reconsideration requests, or formal payer disputes.
• Proficiency with medical billing or practice management software and online payer portals.
• Strong organizational skills and ability to manage multiple accounts, deadlines, and follow-up priorities.
• Excellent written and verbal communication skills, including professional but assertive communication with insurance…