Collections Specialist - Revenue Cycle Management

Vital Care Infusion Services•Dallas, TX

1d•Remote

About The Position

The Collections Specialist performs revenue cycle management duties to collect Home Infusion claims, with an emphasis on accuracy, timeliness, and adherence to processes that reduce denials, days sales outstanding (DSO), and bad debt. The role identifies additional revenue opportunities and works to improve collection rates within standard or accepted practice limits. This is a full-time, 100% remote position, and work must be performed from within the United States. The specialist reviews claims with outstanding balances and follows up with insurers and patients to collect payment while supporting enduring customer and business relationships. The role uses payer portals and reviews explanations of benefits, remittance advices, and other claim documents to identify denials and acceptance status. It investigates denial causes, takes corrective action, and manages claims through collection. The specialist also analyzes denial trends, recommends process improvements, identifies payer appeal requirements, verifies insurance, obtains medical records, reviews claim coding, compiles supporting documents, and submits appeals. The role communicates collection status and resolves payer concerns with franchise partners, patients, and internal departments; documents account activity and schedules follow-ups; investigates and verifies pharmacy and medical benefits; and communicates financial obligations to patients before therapy begins. The specialist also contributes billing expertise to training and process materials and assists with online adjudication of collection issues and nurse billing as assigned.

Requirements

2–5 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.
Demonstrated 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 documentation.
Knowledge of and skill in using Microsoft Office software and pharmacy applications.
Ability to complete 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 working remotely.
Detail-oriented approach 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 customer and business relationships.
Use payer portals and review explanations of benefits, remittance advices, and other claim documents to determine claim status.
Identify denial reasons, take corrective action, and manage claims through timely collection.
Analyze denials, identify trends, and recommend process improvements to reduce DSO and bad debt and improve collection rates.
Identify payer requirements for appeals; verify insurance, order medical records, review claim coding, compile documentation, and submit appeals according to payer requirements and company processes.
Communicate collection status with franchise partners and other departments and resolve payer issues and concerns in a timely manner.
Document case activity, communications, correspondence, and actions 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 identified during collections to help prevent recurrence.
Explain patients’ financial obligations and therapy costs before service begins.
Contribute medical billing expertise to training and knowledge-transfer programs, materials, policies, and procedures for the RCM team.
Assist with online adjudication of collection issues and nurse billing as assigned.
Perform other related duties as assigned.