Job Description
POSITION SUMMARY: The Collections Lead is responsible for directing the team that manages all collections functions from payers and patients after claims have been processed. This role requires an in-depth understanding of the denial appeals process, strong negotiation skills, and a strategic approach to recovering outstanding balances efficiently and compliantly.
ESSENTIAL RESPONSIBILITIES AND DUTIES INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING:
- Leads and mentors the collections staff, defining daily workflow, providing performance coaching, and ensuring all collection activities meet productivity and compliance targets.
- Develops and executes strategic plans for collecting outstanding balances from Medicare, Medicaid, commercial payers, and self-pay patients, focusing on the oldest and highest-dollar accounts.
- Oversees the complex process of researching, appealing, and resolving all payment denials efficiently, ensuring all necessary documentation (e.g., medical records, authorization) is included to overturn the denial.
- Serves as the primary point of contact for high-level communication with payer representatives to negotiate payment and resolve complex, systemic payment discrepancies.
- Directs the process for patient financial counseling and collections, ensuring all communication is professional, empathetic, and compliant with FDCPA (Fair Debt Collection Practices Act) guidelines.
- Tracks, analyzes, and reports on key collections metrics, including denial rates, collection effectiveness, and trends in non-payment to identify areas for improvement in upstream processes (Intake, Authorization, and Billing).
- Other appropriate services and special projects as assigned.
The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.
QUALIFICATIONS & REQUIREMENTS FOR THE POSITION:
- At least three (3) years of experience in healthcare collections, accounts receivable follow-up, or denial management, with experience in home health or hospice preferred.
- At least one (1) year of leadership or supervisory experience managing a collections team.
- Deep, demonstrable understanding of the Medicare and Medicaid appeals process (e.g., Redetermination, Reconsideration).
- Proven ability to interpret Explanation of Benefits (EOBs), remittance advices, and payer contracts.
- Proficiency in using collection management modules within major EMR systems.
Job Type: Full-time
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Vision insurance
Experience:
- healthcare collections, accounts receivable: 3 years (Required)
- managing a collections team: 1 year (Required)
Work Location: Hybrid remote in Nashville, TN
