Collections Representative/Claims Audit Coordinator

Job Description: The Collections Representative / Claims Audit Coordinator is responsible for managing value-based reimbursement processes, resolving claims, and ensuring accurate and timely collections. This role requires strong analytical skills, knowledge of managed care and medical terminology, and the ability to work collaboratively in a fast-paced healthcare environment. Key Responsibilities: Complete Value-Based Reimbursement processes accurately and on time, following best practices and company policies. nalyze, audit, and resolve assigned claims promptly. Communicate with insurance carriers, physician offices, patients, and management to ensure smooth claims resolution. Verify and update patient insurance benefits. Process payment postings and account adjustments accurately. Prepare and submit claim appeals when necessary. Obtain medical records and supporting documentation to secure complete and timely reimbursement. Maintain accurate documentation of account activities and follow-up actions. Required Qualifications: Minimum of 2 years of experience in medical collections or value-based care accounts. Strong analytical ability to interpret patient accounts and payer Explanation of Benefits (EOBs). Solid understanding of managed care contracts, reimbursement processes, and medical terminology. Strong problem-solving skills with ability to resolve complex claims efficiently. Excellent verbal and written communication skills. Proficiency in MS Word, Outlook, and Excel. Experience working with Electronic Health Records (EHR) systems. Highly organized with ability to manage multiple priorities and meet deadlines. bility to thrive in a fast-paced environment while maintaining accuracy and professionalism. Self-motivated and team-oriented with strong collaboration skills. Preferred Qualifications: ssociate or Bachelor's degree. Specialty care collections experience, particularly in cardiology. Certified Professional Coder (CPC) certification. Skills: Medical claims analysis and auditing. Insurance verification and payment posting. ppeals management. Managed care and contract knowledge. Time management and multitasking. Education: ssociate or Bachelor's degree preferred; equivalent experience considered.

Created: 2026-03-08