Collections Specialist

About Zealie LLC

Zealie is a fast-growing Medical Billing company specializing in the Behavioral Healthcare industry. Our clients are substance use disorder treatment, addiction recovery, and mental health treatment centers that are saving lives on a daily basis. Our state of the art proprietary technology provides data analytics and revenue prediction tools to our clients to help them make strategic business decisions to grow their business. We are committed to delivering exceptional products and services to our clients and believe that our team plays a crucial role in achieving this mission. We are seeking motivated individuals with a desire to be a part of a winning team.

Job Summary

The Collections Specialist works an assigned inventory of insurance accounts receivable for the clients in one of Zealie's six Collections pods. Reporting to a Collections Team Lead, the Specialist statuses and resolves unpaid, underpaid and denied claims, posts insurance payments, and documents every account so any teammate can pick it up.

The role is internal. Specialists do not contact clients or join client meetings unless their supervisor directs it.

Responsibilities and Duties

AR follow-up on assigned inventory

• Receive the daily assignment from your Team Lead and work every assigned account within the allotted time frame.
• Work in priority-tier order: Tier 1 (stop and do now) first, then Tier 2 (this week), then Tier 3 (routine), as defined in the Pod RACI.
• Status claims by phone and payer portal, meeting Zealie's 50/50 call-to-portal ratio.
• Follow up on rejected, denied, delayed and underpaid claims until they are reprocessed or resolved.
• Watch timely-filing and appeal deadlines on every assigned claim; flag any deadline within 5 business days to your Team Lead as Tier 1.
• Use Zealie's tools to build a full picture of a stagnant claim and share it with your Team Lead where needed.

Denials, payments and TPA offers

• Review and research denials and partial payments to find the root cause (authorization, medical necessity, COB, eligibility, coding or billing error).
• Prepare corrected claims, reconsiderations and appeals per the Collections SOP, and route them for SME or Team Lead review where the SOP requires it.
• Enter all insurance payments received into the Billing Logs and confirm each payment against the EOB or ERA.
• Review Third Party Administrator (TPA) offers daily; coordinate with your Team Lead and Collections Manager on what is offered; respond to the TPA; update the Logs; and save files to the Forward Folder.
• Raise repeat denial patterns by payer or level of care to your Team Lead so they can be fixed upstream.

Correspondence and the pod inbox

• Review correspondence daily and make the appropriate changes in the client's Log.
• Work your own items in the pod's shared Collections inbox (Pod Inbox): move each one through Assigned, In progress, Waiting and Completed, and reference the claim or Zion record.
• Use approved reply templates for payer correspondence.
• Do not reply to clients or join client meetings unless your supervisor directs it. Client communication is owned by the CSM and Collections Manager.

Documentation, coverage and knowledge sharing

• Note every account you touch to the Collections minimum documentation standard, so any teammate can pick it up.
• Act as primary or secondary coverage per your pod's coverage roster, and leave handoff notes before planned time off.
• Float to another pod when your Collections Manager assigns it, and follow that pod's priorities while there.
• Submit your production at the end of each day for your Team Lead's and Quality Compliance team's review.

Escalation and communication

• Escalate internal blockers (payer portal access, VOB or billing dependency, documentation gap) to your Team Lead the same day.
• Flag anything that could affect a client, such as a large recoupment or a missed deadline, to your Team Lead so the Collections Manager can involve the CSM.
• Take work direction from your Team Lead and Collections Manager. Requests from a CSM or another pod come to you through them.
• Tell your Team Lead early if work cannot be completed on time, or if you finish early and can take more claims.

Standards and improvement

• Follow the Collections Department SOPs, which are one standard across all six pods, using the Collections SOP Directory.
• Receive routine feedback from your supervisors and QC on the quality and quantity of your work, and apply it.
• Adapt to process improvements for the benefit of Zealie and its clients.
• Perform other duties as requested by your direct supervisor or management.

Qualifications

Required

• 3–5 years of experience in Collections or AR, with demonstrated expertise in handling complex cases.
• High school diploma, Senior School Certificate or equivalent.
• Ability to work private insurance denials through to proper adjudication.
• Ability to use payer portals to verify eligibility, claim status and remittance details.
• Ability to read and interpret an Explanation of Benefits (EOB) and Electronic Remittance Advice (ERA).
• Clear verbal and written communication by phone and email.

Preferred

• Quality score of 96% or above.
• Experience in a behavioral health billing setting.
• Experience in the substance use disorder or mental health treatment industry.
• Experience statusing 50+ claims per day.
• Experience reviewing insurance correspondence.
• Experience reviewing TPA or repricing offers.
• Working knowledge of commercial payer rules (for example UHC, Anthem, Aetna, Cigna), including authorization and timely-filing limits.
• Comprehensive knowledge of all levels of care: Detox, RTC, PHP, IOP, OP and Aftercare.

Core competencies:

• Excellent organization across a daily inventory of many accounts.
• Sound judgment on work order, using the priority tiers rather than first-in, first-out.
• Clear, complete account notes that another Specialist can act on without asking.
• Confident, persistent communication with payer representatives.
• Ownership: raising blockers, risks and spare capacity early.
• Openness to feedback and to changing processes.

Compliance, Work Conditions and Growth

• HIPAA: Access patient information only in Zealie-approved systems and only as much as the task needs. Never move it to personal email, chat or devices. Complete all required HIPAA and compliance training.
• Remote setup: A reliable internet connection and a private workspace where calls and screens cannot be overheard or seen.
• Schedule: Shift timing is set by your Collections Manager and Team Lead, and PTO follows the Collections out-of-office SOP.
• Growth path: Specialists who sustain strong quality and production can be considered for SME and Team Lead roles.