What does a medical collections specialist do?
Medical collections specialists are responsible for the collection of insurance claims. The responsibilities of this position include locating debtors, contacting debtors to address the overdue payments, keeping records of debts, collecting updated information on client accounts and payments, processing payments, and reviewing records to ensure they are accurate. They also conduct follow ups for insurance reimbursement, repossess claims, draft appeals, and resolve unpaid claims.
Medical collections specialist responsibilities
Here are examples of responsibilities from real medical collections specialist resumes:
- Manage accounts for healthcare clients, review detailed patient information for payment resolution while abiding HIPPA privacy and security regulations.
- Job duties include collecting on HMO, PPO, Medicare, and HMO Medicaid.
- Work directly with Medicare and HMO Medicaid plans, and statewide HMO/PPO/POS plans.
- Reprocess denied medical claims using extensive appeal tactics or special appeals processing instructions for commercial and government carriers.
- Adhere to all HIPAA guidelines as well as various policies and guidelines.
- Provide itemized billing statements and screen HIPAA authorization forms for hundreds of legal firms.
- Resolve denied/rejected invoices and prepare payer corrections and or appeals.
- Review accounts and assist with resolving outstanding balances with patients from clinic visits forwarding them to in-house collection agents if necessary
- Complete precise billing procedures for private-pay patients as indicated by insurance coverage, complying with stringent regulations and privacy policies.
- Conduct brief financial analysis to facilitate negotiation of repayment arrangement, up to and including referring account to loss mitigation.
- Analyze and code procedures and diagnosis using ICD-9 & CPT-4 codes.
- Enter diagnosis, procedure, and HCPCS.
- Assist with the charge master review, insurance set-up in system, claim edits and pharmacy NDC + HCPCS set-up.
- Process check-by-phone and/or ACH requests accurately.
Medical collections specialist skills and personality traits
We calculated that 19% of Medical Collections Specialists are proficient in Patients, Healthcare, and Medical Collections. They’re also known for soft skills such as Listening skills, Negotiating skills, and Speaking skills.
We break down the percentage of Medical Collections Specialists that have these skills listed on their resume here:
- Patients, 19%
Reviewed accounts and assisted with resolving outstanding balances with patients from clinic visits forwarding them to in-house collection agents if necessary
- Healthcare, 14%
Worked on Workers Compensation, Third party Liability, Healthcare claims.
- Medical Collections, 7%
Conducted monthly team member evaluations providing positive employee feedback for productive medical collections strategies.
- Medicaid, 5%
Trained staff on Reviewing and correcting denials from clearing house, commercial insurance, Medicare and Medicaid.
- Patient Accounts, 5%
Review detailed patient accounting information for payment resolution by utilizing ResQ on a daily basis and document all activity appropriately.
- Appeals, 5%
Reprocessed denied medical claims using extensive appeal tactics or special appeals processing instructions for commercial and government carriers.
"patients," "healthcare," and "medical collections" are among the most common skills that medical collections specialists use at work. You can find even more medical collections specialist responsibilities below, including:
Listening skills. The most essential soft skill for a medical collections specialist to carry out their responsibilities is listening skills. This skill is important for the role because "collectors must pay attention to what debtors say when trying to negotiate a repayment plan." Additionally, a medical collections specialist resume shows how their duties depend on listening skills: "follow the regulation for hippa and phi skill used effective communication and listening skills. "
Negotiating skills. Many medical collections specialist duties rely on negotiating skills. "the main aspects of a collector’s job are reconciling the differences between two parties (the debtor and the creditor) and offering a solution that is acceptable to both parties.," so a medical collections specialist will need this skill often in their role. This resume example is just one of many ways medical collections specialist responsibilities rely on negotiating skills: "utilized negotiating skills to create mutually agreed upon payment arrangements assisting the consumer in alleviating debt burden and clearing credit issues. "
Speaking skills. This is an important skill for medical collections specialists to perform their duties. For an example of how medical collections specialist responsibilities depend on this skill, consider that "collectors must be able to speak to debtors to explain their options and ensure that they fully understand what is being said." This excerpt from a resume also shows how vital it is to everyday roles and responsibilities of a medical collections specialist: "presented patients with all available payment assistance options. ".
The three companies that hire the most medical collections specialists are:
- Pediatric Partners, now a member of the Sevita family23 medical collections specialists jobs
- National Mentor Holdings Inc.
9 medical collections specialists jobs
- Robert Half8 medical collections specialists jobs
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Compare different medical collections specialists
Medical collections specialist vs. Payment processor
A payment processor is responsible for managing and informing the clients of their payment obligations for the services offered by a financial institution or other related organizations. Payment processors record transactions and ensure the timely completion of account statements. They discuss the terms and conditions of the service contract with the clients and respond to their inquiries and concerns. A payment processor must have excellent communication and organizational skills, especially in coming up with repayment plans and solutions for clients who are not able to pay services in time.
While similarities exist, there are also some differences between medical collections specialists and payment processor. For instance, medical collections specialist responsibilities require skills such as "healthcare," "medical collections," "appeals," and "self pay." Whereas a payment processor is skilled in "customer service," "ach," "credit card payments," and "patient payments." This is part of what separates the two careers.
Payment processors really shine in the insurance industry with an average salary of $38,534. Comparatively, medical collections specialists tend to make the most money in the professional industry with an average salary of $38,414.On average, payment processors reach similar levels of education than medical collections specialists. Payment processors are 1.2% more likely to earn a Master's Degree and 0.1% less likely to graduate with a Doctoral Degree.Medical collections specialist vs. Billing representative
A billing representative assists with the overall operations of the organization's billing department. Billing representatives post payments timely on the database, update account statements, generate financial reports, release invoices, and resolve account discrepancies. They also perform client accounts reconciliation as needed, monitor account receivables, review overdated balance, and notify clients of payment updates to ensure accurate and timely billing. A billing representative must have strong analytical and communication skills to manage clients' accounts, as well as comprehensive knowledge on the accounting industry to explain the payment terms and policies of an organization to a client.
While some skills are similar in these professions, other skills aren't so similar. For example, resumes show us that medical collections specialist responsibilities requires skills like "healthcare," "medical collections," "self pay," and "phone calls." But a billing representative might use other skills in their typical duties, such as, "customer service," "medical billing," "medical terminology," and "eob."
On average, billing representatives earn a lower salary than medical collections specialists. Some industries support higher salaries in each profession. Interestingly enough, billing representatives earn the most pay in the technology industry with an average salary of $35,295. Whereas medical collections specialists have higher pay in the professional industry, with an average salary of $38,414.billing representatives earn similar levels of education than medical collections specialists in general. They're 0.6% more likely to graduate with a Master's Degree and 0.1% more likely to earn a Doctoral Degree.Medical collections specialist vs. Billing associate
A billing associate is responsible for processing payments and invoices for customers and ensuring accurate financial reports for auditing purposes. Billing associates utilize the business' accounting systems to monitor billing transactions and resolve account discrepancies accordingly. They also update customer records in the database, post payments timely, and escalate outstanding bills to the supervisor for resolution. A billing associate reaches out to the clients and customers for payment responsibility and respond to the inquiries and concerns they may have.
There are many key differences between these two careers, including some of the skills required to perform responsibilities within each role. For example, a medical collections specialist is likely to be skilled in "healthcare," "medical collections," "self pay," and "account balances," while a typical billing associate is skilled in "customer service," "medical billing," "insurance billing," and "billing inquiries."
Billing associates earn the best pay in the technology industry, where they command an average salary of $37,737. Medical collections specialists earn the highest pay from the professional industry, with an average salary of $38,414.When it comes to education, billing associates tend to earn similar degree levels compared to medical collections specialists. In fact, they're 2.4% more likely to earn a Master's Degree, and 0.0% more likely to graduate with a Doctoral Degree.Medical collections specialist vs. Billing assistant
A billing assistant is primarily in charge of performing support tasks to maintain smooth billing operations in an establishment. Their responsibilities typically include preparing and processing invoices for clients, sending billing adjustments, printing and reviewing invoices and billings, receiving payments, and monitoring delinquent invoices, sending reminders as necessary. They may also close and balance payments, calculate discounts, and maintain records of all transactions. Moreover, a billing assistant must be alert and proactive for any errors and inconsistencies, dealing with them accordingly.
Types of medical collections specialist
Updated January 8, 2025
