Collections SME

**This is a Remote position**

About Zealie

Zealie is a fast-growing Medical Billing Services 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 Collections 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

Under the supervision of the Collections Manager, the Collections SME is responsible for administrative tasks and collection of outstanding account receivables and all other aspects of collections, analysis and resolution of billing problems. The Collections SME is also responsible for assisting the Collections Team Lead and Collections Manager with any high level task. The position requires the ability to manage complex claims processing tasks, think critically, solve problems, and provide updates and feedback to the Collections Specialists, Team Lead, Manager, Internal Departments and clients. The Collections SME may also assist in daily activities when needed to ensure deadlines are met. Work will primarily be internal, but may be client facing as needed. Collections SME may respond to Clientele by email and join Client meetings as needed.

Responsibilities and Duties:

• Maintain Collections SME responsibilities, including but not limited to:
• Conduct Root Cause Analyses (RCA) on recurring claim issues, payer trends, and process inefficiencies to identify systemic problems and develop sustainable solutions.
• Analyze and interpret claims and denial data to recognize performance patterns, optimize processes, and support departmental improvement initiatives.
• Review and interpret key performance indicators (KPIs) and collection trends to identify opportunities for improvement and efficiency.
• Prepare analytical summaries and reports highlighting performance metrics, claim cycle bottlenecks, and RCA findings.
• Present actionable insights and data-driven recommendations to leadership for continuous operational improvement.
• Conduct an audit for claims that are in specific statuses related to Moving Claims to the Medical Records / Appeals Team
• Assist Team Lead in completing invoicing on time which may include conducting an invoice audit
• Review the emails received from the System's automation to ensure claims are being moved appropriately
• Review all claims that have been Escalated to SME in the Claim Logs each week and work to resolve them
• Review all claims PENDING REQUEST TO APPEAL each day and move them as needed
• Handle high-level tasks and special projects given to you by the Collections Team Lead and Manager
• Maintain these standards when statusing high-level claims:
  • Review and research denials and partial payments
  • Status Claims in an effort to reprocess any claim that is delayed in payment (i.e. rejected, denied)
  • Utilize the tools Zealie offers to make informed decisions when working a stagnant claim, and provide a full picture of the issue at hand to the Collections Manager, Team Lead, and/or Client as needed
• Report to immediate supervisor if work is unable to be completed in a timely manner
• Report to immediate supervisor if work is finished early
• Adhere to the Collections Department Standard Operating Procedures
• Receive routine constructive feedback from your supervisor(s) and/or QC regarding quality and quantity of work completed, considering both the Standard Operating Procedures and working knowledge of this industry
• Assist Collections Team Lead and Collections Manager as needed
• Assume the Collections Team Lead's responsibilities when they are out of the office, including but not limited to:
• Review and provide feedback on the team's daily production
• Review and respond to any Third Party Administrator offer for your team
• Review and resolve any high level task and/or escalation from your team, supervisor, and/or client
• Routinely review specific claim statuses as advised by management
• Ensure accuracy of payments for invoicing
• Ensure work is covered when a Collections Specialist (CS) is out of the office
• Attend internal and client meetings, as needed
• Coordinate the credentialing and contracting of new and/or existing facilities
• Onboard new clients
• Perform additional duties as requested by direct Supervisor and/or Management

Qualifications and Skills

• Strong analytical and critical-thinking skills, with experience in identifying trends, inefficiencies, and process improvements through quantitative and qualitative data review.
• Excellent organizational and time management skills with the ability to prioritize multiple complex tasks, projects, and audits simultaneously.
• Proficiency in using analytical tools and reporting methods to track key performance metrics, monitor trends, and support decision-making.
• Ability to successfully navigate private insurance denials for proper adjudication
• Ability to navigate Payer Portals to verify eligibility, claim status, and remittance details
• Effective communication and collaboration skills, both verbal and written, with the ability to clearly convey analytical findings to leadership, clients, and team members.
• Proficiency utilizing Electronic Health Record Systems & Billing Software such as Kipu, ZenCharts, BestNotes, SunWave, CollaborateMD.
• Proficiency in Google Products including Google Workspace, Google Drive, Google Sheets, Google Docs
• Ability to navigate various technology and software tools such as Zoom, eFax software, Adobe, Systweak

Education and Experience:

• Minimum of 3-5 years of experience in the Collections / AR process, with demonstrated expertise in handling complex cases.
• High School Diploma, Senior School Certificate, or the equivalent.

(Preferred):

• Quality Score that meets or exceeds Zealie's expectations for 6 consecutive months
• Has been employed as a Collections Specialist with Zealie for at least 6 months
• Experience in assisting a supervisor on special projects and staff on complex AR cases
• Experience working in a behavioral health billing setting
• Experience working in Substance Abuse/Mental Health Treatment Industry
• Experience statusing 50+ claims per day
• Comprehensive knowledge of all levels of care (Detox, RTC, PHP, IOP, OP, Aftercare)