Collections Specialist I - HMO / PPO - Remote

Job Summary

The Collections Specialist I - HMO / PPO is responsible for performing collection follow-up on outstanding insurance balances, identifying claim issues, and ensuring timely resolution in compliance with government and managed care contract terms. This role requires effective communication with insurance payers, documentation of account activity, and adherence to applicable regulations to support revenue cycle operations.

As a Collections Specialist II at Community Health Systems (CHS) - SSC Nashville, you'll play a vital role in supporting our purpose to help people get well and live healthier by providing safe, quality healthcare, building enduring relationships with our patients, and providing value for the people and communities we serve. Our team members enjoy a robust benefits package including medical, dental and vision, insurance, and 401k.

Essential Functions

Performs follow-up on outstanding insurance balances within the required timeframe, obtaining payment confirmation or required documentation.

Documents all actions taken on accounts within the appropriate system, ensuring a clear and traceable resolution process.

Makes the required number of outbound calls to insurance payers while maintaining professional and courteous communication.

Handles and resolves incoming correspondence within five days of receipt, updating the system with relevant information.

Analyzes assigned accounts using AS400, Meditech, Accurint, Cerner, directory assistance, and credit reports to maximize collection efforts.

Processes inbound and outbound calls professionally, providing exceptional customer service while resolving outstanding balances.

Ensures proper application of account dispositions and follows self-pay policies and procedures.

Adheres to all local, state, and federal laws and regulations, including FDCPA, TCPA, FCRA, CFPB, PCI, UDAAP, and HIPAA compliance standards.

Performs other duties as assigned.

Maintains regular and reliable attendance.

Complies with all policies and standards.

This is a fully remote position.

Qualifications

H.S. Diploma or GED required

Associate Degree in Business, Finance, Healthcare Administration, or a related field preferred

0-2 years of experience in medical collections, accounts receivable, billing, or healthcare revenue cycle operations required

Experience working with insurance follow-up, claim resolution, and payer communication in a healthcare setting preferred

Knowledge, Skills and Abilities

Strong understanding of medical collections processes, payer reimbursement policies, and insurance claim resolution.

Proficiency in electronic medical record (EMR) systems, patient accounting systems, and collections software.

Knowledge of insurance contracts, denials management, and accounts receivable workflows.

Excellent problem-solving and analytical skills to research and resolve outstanding claims.

Effective verbal and written communication skills to interact with insurance payers, patients, and internal teams.

Strong attention to detail with the ability to document account activity accurately.

Ability to work independently in a fast-paced environment while meeting productivity and quality standards.

Knowledge of regulatory compliance, including HIPAA, FDCPA, and applicable healthcare finance laws.

We know it's not just about finding a job. It's about finding a place where you are respected, valued and where your work is purposeful and fulfilling. A place where your talent is recognized, professional development is encouraged and career advancement is possible.

The Shared Services Center - Nashville provides business office support functions like billing, insurance follow-up, call center customer service, data entry and more for hospitals and healthcare providers. But we're not only about work. We know employing a skilled and engaged team of professionals is vitally important to our success, so we make sure to offer competitive benefits, recognition programs, professional development opportunities and a fun and engaging team environment.

Community Health Systems is one of the nation's leading healthcare providers. Developing and operating healthcare delivery systems in 40 distinct markets across 15 states, CHS is committed to helping people get well and live healthier. CHS operates 71 acute-care hospitals and more than 1,000 other sites of care, including physician practices, urgent care centers, freestanding emergency departments, occupational medicine clinics, imaging centers, cancer centers and ambulatory surgery centers.

Equal Employment Opportunity

This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to : hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to to obtain the main telephone number of the facility and ask for Human Resources.