Collections Specialist - RCM

Vital Care Infusion Services•Monroeville, PA

3h•Remote

About The Position

The Collections Specialist performs revenue cycle collection duties for Home Infusion claims, focusing on accuracy, timeliness, and adherence to established processes to reduce denials, days sales outstanding (DSO), and bad debt. The role identifies additional revenue opportunities and works to improve collection rates while operating within standard or accepted practices. This is a full-time, 100% remote position, and work must be performed from within the United States. The specialist reviews outstanding claims, follows up with insurers and patients, investigates denials, and takes corrective action through successful collection. The role also supports appeals, benefits verification, account documentation, communication with franchise partners and internal departments, and improvements to RCM training and processes.

Requirements

Two to five years of home infusion billing and/or collections experience.
High school diploma and additional specialized training in intake, pharmacy or medical billing, and/or collections.
Excellent English communication skills, including listening, speaking, understanding, and writing, with the ability to influence patients, caregivers, payer representatives, and others.
Understanding of processes, systems, and techniques for successful billing and collections across payer types.
Ability to identify documentation gaps and problems, determine lasting solutions, make effective decisions, and take corrective action.
Strong organizational skills and ability to maintain clear, complete records of activities, cases, and related documentation.
Knowledge and skill using Microsoft Office software and pharmacy applications.
Ability to complete job duties in a designated workspace outside the dedicated RCM location.
Disciplined work ethic and ability to work remotely with minimal direct supervision while meeting production and collection targets.

Nice To Haves

Previous experience in a remote work environment.
Attention to detail and post-billing and post-payment investigative experience.

Responsibilities

Review claims with outstanding balances and identify actions to collect revenue.
Follow up with insurers and patients to collect outstanding balances while building enduring customer and business relationships.
Use payer portals to review claim disposition.
Review Explanations of Benefits, Remittance Advices, and other documents indicating claim denials or acceptance.
Identify reasons for denials, take corrective action, and manage claims through timely, successful collection.
Analyze denial trends and recommend process improvements to reduce DSO and bad debt, improve collection rates, and simplify payer-responsive processes.
Identify payer requirements for appealing denied claims.
Verify patient insurance information, order medical records, review original claim coding, compile supporting documentation, and submit appeals according to payer requirements and company processes.
Communicate collection status with franchise partners and other company departments.
Resolve payer issues and concerns in a timely manner.
Document case activity, communications, and correspondence in the computer system, and schedule follow-ups at required intervals.
Investigate and verify benefits for pharmacy and medical third-party claims.
Communicate billing problems discovered during collections to help prevent recurrence.
Explain patients' financial obligations so they understand therapy costs before services begin.
Contribute medical billing expertise to the development of RCM training, knowledge-transfer programs, materials, policies, and procedures.
Assist with online adjudication of collection issues and nurse billing as assigned.
Perform other related duties as assigned.