Collections Specialist, Aged Insurance Claims

WHY JOIN ALLEGIANCE MEDICAL ENTERPRISES?
At Allegiance Medical Enterprises, our employees play an important role in supporting the patients, communities, and healthcare partners we serve.
We believe every role makes a difference. Whether you're providing patient care, supporting emergency operations, coordinating transportation, or keeping our organization running behind the scenes, your contributions help us deliver dependable, high-quality service every day.
We offer opportunities to learn, grow, develop new skills, and build a rewarding career while working alongside a team committed to making a difference.
If you're dependable, motivated, and looking for an opportunity to grow with an organization where your work matters, we encourage you to apply.
Join the Allegiance team and make a difference!

SUMMARY:

This position is responsible for the follow-up and resolution of aged ground ambulance insurance claims (generally 90 days or older) across Medicare, Medicaid, Medicare Advantage, commercial, and third-party liability payers in support of the Revenue Cycle department. This position is performed in a fully remote work environment. The Collections Specialist investigates why claims remain unpaid, contacts payers to secure payment, pursues appeals and underpayment recovery, and escalates complex accounts to protect revenue and meet timely filing limits. This role requires the ability to work independently, manage time effectively, and maintain HIPAA-compliant data security while operating outside a traditional office setting.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

- Works assigned aged accounts receivable by aging bucket (60, 90, 120+ days), payer, and dollar value, with the goal of reducing days in A/R and meeting monthly collection targets.

- Contacts payers by phone, payer portal, and secure messaging to obtain claim status, confirm receipt, identify the reason for non-payment, and secure payment or a clear resolution date.

- Reviews denials, partial payments, and unprocessed claims; determines the root cause (eligibility, coordination of benefits, medical necessity, authorization, coding, timely filing, or missing documentation); and takes corrective action.

- Prepares and submits corrected claims, reconsiderations, and formal appeals with supporting documentation, including patient care reports (PCR), physician certification statements (PCS), and medical records, and tracks each appeal to resolution.

- Monitors timely filing, appeal, and payer-specific deadlines on all assigned accounts and prioritizes work to prevent avoidable write-offs.

- Identifies underpaid claims by comparing payments to contracted rates, fee schedules, and payer policy; disputes underpayments and follows up until corrected payment is received.

- Investigates accounts with missing or incorrect insurance, coordination of benefits issues, and third-party liability (such as auto, motor vehicle accident, and workers' compensation); obtains updated coverage and rebills accordingly.

- Coordinates with crews, facilities, and internal departments to obtain missing documentation, signatures, and records needed to support payment.

- Documents every contact, payer reference number, promised payment date, and follow-up action clearly and accurately within the billing system, and follows up on all promises to pay.

- Recommends adjustments, write-offs, and referrals to collection agencies in accordance with company policy and submits them to management for approval; does not apply write-offs outside approved authority.

- Escalates payer trends, unresolved disputes, and high-dollar accounts to the Manager with supporting details; tracks and analyzes denial and aging patterns by payer to identify recurring issues and opportunities for improvement.

- Responds to patient and facility inquiries regarding insurance balances through phone, email, secure messaging, and patient portal correspondence.

- Follows applicable HIPAA requirements and company privacy and security policies when accessing, using, and disclosing protected health information (PHI), including maintaining a secure remote work environment and utilizing company-approved systems for handling PHI.

- Utilizes remote collaboration tools (video conferencing, instant messaging, shared dashboards) to stay connected with the billing team and management and proactively communicates any connectivity or equipment issues that may affect productivity.

- Performs other related duties and responsibilities as assigned.

KNOWLEDGE AND SKILLS:

- Strong attention to detail, persistence, and continuous focus on quality and results.

- Strong working knowledge of Medicare, Medicaid, Medicare Advantage, and commercial payer claims processing, appeal rights and timelines, and timely filing requirements.

- Working knowledge of ground ambulance billing, including HCPCS service and mileage codes, modifiers, medical necessity, and documentation requirements.

- Demonstrated knowledge of claim adjustment reason codes (CARCs) and remittance advice remark codes (RARCs), and ability to determine the correct resolution path for each denial type.

- Knowledge of coordination of benefits, third-party liability, and applicable state balance billing protections for ambulance services.

- Ability to analyze aging reports and prioritize accounts by recovery potential.

- Proficient with computers, office equipment, and standard billing/practice management software, as well as remote work technology (VPN, video conferencing, secure messaging, cloud-based document sharing); intermediate Excel skills preferred.

- Outstanding written and verbal communication and negotiation skills, including professional phone and video etiquette.

- Demonstrated ability to work independently, manage a large account inventory, and stay self-motivated and productive without in-person supervision.

- Basic awareness of cybersecurity best practices and data privacy requirements associated with handling PHI outside of a traditional office.

REMOTE WORK REQUIREMENTS:

- Must maintain a private workspace that protects confidential information and prevents unauthorized access to protected health information (PHI).

- Must have reliable internet service sufficient to support company systems, billing applications, and video conferencing.

- Must use company-approved equipment security measures, including VPN, multi-factor authentication, and secure storage and transmission of billing data.

- Must meet designated work schedules, performance expectations, and communication requirements, including participation in scheduled virtual meetings.

PHYSICAL REQUIREMENTS:

- Regularly uses a computer, keyboard, telephone, and other standard office equipment to perform job responsibilities.

- Must be able to perform computer-based work and communicate effectively through appropriate methods in a remote office environment.

- Work is primarily performed in a home-office setting with regular periods of computer-based activity.

MINIMUM QUALIFICATIONS:

- High School Diploma required; Associate degree preferred.

- Minimum of three years of experience in insurance follow-up, collections, or accounts receivable management; ground ambulance or EMS billing experience preferred.

- Demonstrated experience working aged claims and filing appeals with Medicare, Medicaid, or commercial payers.

- Professional certifications such as CRCR, CPB, or Certified Ambulance Coder (CAC) are preferred.

- Previous success working in a remote or telecommute position preferred.

- Working knowledge of electronic health record (EHR) and practice management systems, payer portals, and clearinghouse platforms.

Allegiance Mobile Health is an equal opportunity employer committed to providing a workplace free from discrimination and harassment. We consider qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other status protected by applicable federal, state, or local law. We are committed to providing reasonable accommodation to qualified individuals with disabilities throughout the employment process.