Infusion Revenue Cycle Management Specialist - Collections

Overview

The Revenue Cycle Management Specialist- Collections responsibility is to ensure timely collection of outstanding balances.

Responsibilities

• Manage the collection process for outstanding claims, including contacting insurance companies, patients, and other responsible parties via phone, email, and written correspondence.

• Investigate and resolve denied or partially paid claims, identifying root causes and implementing corrective actions.

• Collaborate with internal teams to address claims challenges and improve revenue cycle.

• Escalate complex or uncollectible accounts to management for further action.

• Submit appeals/claim corrections as needed within timely filing limits.

• Utilize billing software to maintain accurate and detailed records of all collection activities, including communication with payers and patients.

• Payer projects as assigned.

• Identify and report trends in claim denials and payment challenges.

• Communicateasneededwithpatients about billing issues,including theresults ofapplications for financial hardshipassistanceand other responses tocustomerinquiries about

• Support accurate and comprehensive record-keeping to ensure up-to-date information is maintained and effectively shared across departments.

• Assist in the implementation of processesto measure,assess,and improve the performance of the RCM departmentactivities of thecompany.

• Ensure ongoingcompliance with alllawsandregulations;ensurethat the department meets orexceedsaccreditation standards; and implement "best practices" in all departmental

• Participate insurveysconductedby authorized inspection

• Participate in the company's Performance Improvement program as requested by thePerformance Improvement

• Participate incompany committees when

• Participate in in-service education programsprovided by the company.

• Pursuecontinuing education programs appropriateto job

• Performotherduties as assigned by

• Complete all mandatory and regulatory training programs.

• Reportanymisconduct,suspicious orunethicalactivitiesto the Compliance

• Complies with accepted professional standards and practice.

Qualifications

Job Skill Requirements:

• Ability to read and interpret medical records for billing purposes.

• Competent in mathematic equations.

• Ability to compute unit conversions for drugs.

• Understanding of CPT, HCPCS, ICD-10, and NDC codes

• Diligent attention to detail.

• Excellent verbal and written communication.

• Understanding of HIPAA compliance.

• Self-directed, has the ability to work with little supervision.

• Proficiency in Excel, Outlook, and all other office applications.

• Familiarity with pharmacy management systems (CPR+, Wellsky, and CareTend, etc.)

• Understanding of various insurance plan benefits, payer payment policies, and reimbursement procedures.

• Deep understanding of home infusion process, therapies, and related services.

• Ability to understand payer explanation of benefits.

Educational Requirements:

• High school diploma or GED

Experience:

• One to three years of experience in Home Infusion or Specialty Pharmacy collections.

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Job Locations US-OH-Maumee

Posted Date 1 year ago (2/15/2025 3:24 PM)

Requisition ID 2025-13808

# of Openings 1

Category Accounting/Finance

Location : Location US-OH-Maumee