Collections Specialist Medical Billing

Collections Specialist Medical Billing
Sunshine Kids Pediatric Center (Dallas, TX)

About Us
Sunshine Kids Pediatric Center is a state-licensed Prescribed Pediatric Extended Care Center (PPECC) in Dallas, TX, specializing in providing daytime medical services for children with complex healthcare needs. Our mission is to deliver compassionate, coordinated care that supports both patients and their families.

Position Overview
We are actively seeking a Collections Specialist with a strong medical billing background to lead our reimbursement recovery process. This role is critical in ensuring the center receives timely and complete payments from Medicaid and private insurers. The ideal candidate brings a proactive, assertive approach to managing outstanding balances, resolving denied or underpaid claims, and optimizing collection strategies. While this role does not require CPT coding, knowledge of claims workflows and payer-specific billing rules is essential.

Key Responsibilities

• Accounts Receivable Management: Monitor aging reports, identify trends in outstanding balances, and prioritize follow-up actions on unpaid or denied claims.

• Insurance Follow-Up: Actively engage with Medicaid and private insurance carriers to resolve unpaid or delayed claims. Investigate denials, initiate appeals, and resubmit claims when necessary.

• Discrepancy Resolution: Reconcile discrepancies between billed amounts and remittance advices. Document root causes of recurring issues and collaborate with internal teams to prevent future rejections.

• Authorization & Verification Coordination: Partner with the billing team to ensure authorizations are obtained and coverage verified prior to services being billed. Assist in collecting missing information to support claims.

• Patient Account Support: Serve as a point of contact for patient families regarding balances, insurance questions, and payment plans as needed, maintaining empathy and professionalism.

• Reporting & Analytics: Maintain up-to-date collection metrics, contribute to month-end reporting, and provide management with insights and status updates on revenue recovery activities.

• Compliance: Ensure all collection activities adhere to HIPAA guidelines and payer-specific regulations. Maintain thorough documentation and audit trails for every interaction and follow-up.

Required Qualifications

• Minimum 2 years of medical collections or billing experience, with direct responsibility for Medicaid and private payer follow-up. PPECC, pediatric, or home health experience strongly preferred.

• Strong working knowledge of healthcare billing processes, EOB interpretation, denial reasons, and appeal protocols.

• Proficiency in using medical billing software, electronic health records (EHR), and Microsoft Excel.

• High school diploma or equivalent; certification in medical billing or revenue cycle (CPB, CMRS, etc.) is a plus.

• Proven ability to manage A/R reports, meet recovery targets, and communicate effectively with insurance carriers.

Preferred Experience

• Familiarity with Texas Medicaid managed care plans and associated portals.

• Experience coordinating benefits and handling complex pediatric care reimbursement.

• History of driving process improvements in collections workflows or systems.

Key Competencies

• Persistent & Goal-Oriented: Demonstrates tenacity in securing payments and resolving complex account issues.

• Analytical Thinking: Able to identify trends, spot errors in billing or claim history, and determine corrective actions quickly.

• Clear Communicator: Skilled in articulating issues and follow-ups with payers and patient families alike.

• Detail-Oriented: Accuracy in documenting, reporting, and tracking claim status and payment outcomes.

• Team Collaboration: Works closely with billing, clinical, and administrative staff to ensure alignment across revenue cycle processes.

• Professional Integrity: Maintains the highest level of confidentiality and ethical standards.

Join Our Team
If you are a revenue-minded billing professional with a passion for pediatric healthcare and a drive to improve reimbursement outcomes, we invite you to bring your expertise to Sunshine Kids Pediatric Center. Help us support children with special medical needs by ensuring their care is financially sustainable and administratively sound.