Major Medical Collector

Job Description

Job Description

The Major Medical Collector is responsible for overseeing accounts receivable and collections for a home health agency and specialty pharmacy. This role ensures timely reimbursement from insurance payors, manages claim denials, and supports accurate financial operations. The Collector serves as a key liaison between the agency, pharmacy, patients, and payors, with a focus on compliance, accuracy, and efficiency in revenue cycle management

QUALIFICATIONS:

• Minimum 5 years of experience in medical collections, with specific knowledge of home health and/or specialty pharmacy billing.
• Strong understanding of Medicare, Medicaid, and commercial insurance payor processes.
• Experience with claim denials, appeals, and reimbursement procedures for home health services and specialty medications.
• Proficiency with medical billing systems, electronic health records (EHR), and pharmacy benefit systems. CPR +, (Mediware) and/or Caretend software is a plus
• Excellent organizational, analytical, and problem-solving skills.
• Strong communication skills with the ability to interact professionally with patients, payors, and internal staff.

RESPONSIBILITIES:

• Review and reconcile Accounts Receivable (A/R) reports to track and manage outstanding balances.
• Participate in productivity calls to provide updates on collection status and goals.
• Submit appeals or correct claims assigned to payors, ensuring accuracy and compliance with home health and specialty pharmacy requirements.
• Answer incoming calls from patients, payors, and internal teams, addressing billing inquiries and claim issues.
• Follow up on appeals and corrected claims to secure resolution and payment.
• Prepare and maintain correspondence with assigned payors, documenting communication and progress.
• Conduct targeted collections efforts for specialty pharmacy claims, including high-cost medications and therapies.
• Conducts Job duties in accordance with established policies procedures and acceptable work standards of the industry.
• Actively participates in the Oso’s process improvement program.

Core Competencies

• Accuracy & Compliance: Ability to work with detailed billing requirements specific to home health and pharmacy services.
• Collections Expertise: Skilled in follow-up, appeals, and negotiation with payors to minimize aging A/R.
• Patient-Centered Service: Provide respectful and professional communication to patients and caregivers regarding billing inquiries.
• Collaboration: Work effectively with clinical, pharmacy, and administrative teams to resolve issues impacting reimbursement.

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