Collections Specialist - Revenue Cycle Management

Role Description

Perform duties to collect Home Infusion claims, focusing on accuracy, timeliness, and adherence to processes to reduce denial rate, DSO, and bad debt. Recognize additional revenue opportunities and improve collection rates; perform revenue cycle collection duties within standard or accepted practice limits.

Position is 100% remote.

Duties/Responsibilities

• Review claims with outstanding balances and identify actions to successfully collect revenues.
• Follow up with insurers and patients to collect outstanding balances in an environment focused on building enduring customer and business relationships.
• Utilize Payer Portals via the internet for claim disposition.
• Review documents received including Explanations of Benefits (EOBs), Remittance Advices (RAs), and other documents indicating denials or claims acceptance.
• Identify reasons for denials, take required corrective action, and take ownership of claims through to timely, successful collection.
• Analyze denials, identify trends, and recommend process improvement opportunities that will result in DSO reduction, superior collection rate, and reduced bad debt.
• Identify payor requirements for submittal of appeals for denied claims.
• Verify insurance information with patients, order medical records, review original claim coding, compile other validating documentation required, and submit appeals in keeping with payor requirements and VCI processes.
• Communicate effectively with franchise partners and other VCI departments regarding the status of collections.
• Resolve payer issues/concerns timely.
• Document case activity, communications, and correspondence in the computer system to ensure completeness and accuracy of account activity.
• Schedule follow-ups in required intervals.
• Investigate and verify benefits for pharmacy and medical third-party claims.
• Communicate billing problems found during the collection process to avoid the same issues in the future.
• Communicate financial obligation information with patients so that they have a clear understanding of all costs of therapy prior to starting service.
• Contribute medical billing expertise to the design of training and knowledge transfer programs, materials, policies, and procedures.
• Assist with the processing of online adjudication of collection issues and nurse billing as assigned.
• Perform other related duties as assigned.

Required Skills/Abilities

• Excellent communications skills; listening, speaking, understanding, and writing English.
• Proven understanding of processes, systems, and techniques to ensure successful billing and collection working with all payer types.
• Proven ability to identify gaps and problems from the review of documentation.
• Strong organization skills with the ability to track and maintain clear, complete records of activities, cases, and related documentation.
• Proven knowledge and skill in the utilization of MS Office suite of software and pharmacy applications.
• Ability to complete job duties in a designated workspace outside the dedicated RCM location.
• Disciplined work ethic with the ability to work remotely with minimum direct supervision.

Education and Experience

• 2-5 years home infusion billing and/or collections experience required.
• High School Diploma and additional specialized training in intake, pharmacy/medical billing, and/or collections.
• Previous remote work environment is a plus but not required.
• Detail-oriented with post-billing and post-payment investigative experience preferred.

Physical Requirements

• Sitting: Prolonged periods of sitting are typical, often for the majority of the workday.
• Keyboarding: Frequent use of a keyboard for typing and data entry.
• Reaching: Occasionally reaching for items such as files, documents, or office supplies.
• Fine Motor Skills: Precise movements of the fingers and hands for tasks like typing, using a mouse, and handling paperwork.
• Visual Acuity: Good vision for reading documents, computer screens, and other detailed work.

Benefits

• Comprehensive medical, dental, and vision plans, plus flexible spending, and health savings accounts.
• Paid time off, personal days, and company-paid holidays.
• Paid Paternal Leave.
• Volunteerism Days off.
• Income protection programs include company-sponsored basic life insurance and long-term disability insurance.
• 401(k) matching and tuition reimbursement.
• Employee assistance programs include mental health, financial, and legal support.
• Rewards programs offered by our medical carrier.
• Professional development and growth opportunities.
• Employee Referral Program.