Health Claims Collections Specialist II

Orthofix

Health Claims Collections Specialist responsible for resolving complex post-payment and denied DME claims. Analyzing payer trends and collaborating across teams to drive revenue recovery.

Posted 7/16/2026full-timeRemote • Texas • 🇺🇸 United StatesJuniorMid-Level💰 $23 - $26 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates advanced knowledge of revenue cycle management, payer guidelines, and appeals processes, with a strong focus on accuracy and compliance in managing complex claims. Proficient in analyzing denials and implementing corrective strategies while effectively communicating with stakeholders.

Highest-signal resume keywords

Medical Collection ExperienceRevenue Cycle ManagementPayer Guidelines KnowledgeICD-10 ProficiencyMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AnalysisDenial ManagementAppeals ProcessesEOB InterpretationBilling ProceduresPayer OutreachData AnalysisClaim CorrectionsAudit PreparationTrend Identification

Soft Skills

Attention to DetailCommunication SkillsNegotiation SkillsTime ManagementIndependent Work

Tools & Technologies

Medical Billing PlatformsOracleCMS-1500 Forms

Industry Keywords

DME ClaimsOrthopedic ClaimsMedicareMedicaidCommercial Insurance

Tech Stack

Tools & technologies

Oracle

About the role

Key responsibilities & impact

Independently manage a portfolio of high-priority and complex claims requiring advanced solutions and strategies.
Analyze denials, overpayments and underpayments to determine root cause; execute appropriate action plans including appeals, escalations and payer outreach.
Submit technical, clinical and medical necessity appeals at all levels (including external reviews) with supporting documentation.
Research payer contract language, LCD/NCD guidelines and policy updates; apply findings to claims resolution and communicate relevant changes to peers and leadership.
Identify payer trends (example, systemic rejections, denials, overpayments or underpayments) and escalate issues with supporting data to payer contacts and leadership.
Resolve escalated issues involving prepay audits, refund requests, rebills, recoupments and coordination of benefits discrepancies.
Manage HCFA returns and claim corrections, ensuring clean resubmission per billing guidelines.
Communicate effectively with leadership and cross-functional teams to resolve multifaceted claim barriers.
Ensure account documentation is accurate, detailed, and audit ready across all internal system.
Consistently meet or exceed departmental metrics related to productivity, quality, aging resolution, and cash recovery.

Requirements

What you’ll need

Minimum 2+ years of medical collection or revenue cycle experience with emphasis on post-billing DME or orthopedic claims.
Advanced knowledge of payer guidelines, revenue cycle management, and appeals processes (Medicare, Medicare advantage, Medicaid, and commercial insurance payers).
Proficiency in reading and interpreting EOBs, payer policies, LCDs, and prior authorization requirements.
Strong working knowledge of ICD-10, HCPCs and billing procedures for CMS-1500 claim forms.
Proficient in Microsoft Office and medical billing platforms.
Demonstrated experience with complex denials, payer escalations, and appeals at all levels.
Strong attention to detail with the ability to identify trends and implement corrective strategies.
Excellent communication skills and negotiation skills with payers and internal stakeholders.
Ability to work independently, Detail-oriented with a focus on accuracy, time-management and compliance.
Familiarity with Oracle or similar revenue cycle platforms.

Benefits

Comp & perks

Competitive salary
Health insurance
401(k) matching
Flexible working hours
Paid time off
Professional development opportunities