Collections Specialist - RCM

Vital Care Infusion Services•Monroeville, PA

2h•$19 - $23•Remote

About The Position

The Collections Specialist performs revenue cycle management duties to collect Home Infusion claims, focusing 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 position is full-time and 100% remote, with work performed from within the United States.

Requirements

Excellent English communication skills, including listening, speaking, understanding, and writing, to influence patients, caregivers, payer representatives, and others and advance reimbursement and collection efforts.
Proven 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 track and maintain clear, complete records of activities, cases, and related documentation.
Knowledge and skill in using the MS Office suite 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.
2–5 years of home infusion billing and/or collections experience.
High school diploma and additional specialized training in intake, pharmacy/medical billing, and/or collections.

Nice To Haves

Previous experience in a remote work environment.
Detail-oriented approach and post-billing and post-payment investigative experience.

Responsibilities

Review claims with outstanding balances, identify actions needed to collect revenue, and follow up with insurers and patients while building customer and business relationships.
Use payer portals to determine claim disposition.
Review EOBs, remittance advices, and other claim documents; identify denial reasons, take corrective action, and own claims through timely collection.
Analyze denials, identify trends, and recommend process improvements to reduce DSO and bad debt, improve collection rates, and simplify payer-responsive processes.
Identify payer appeal requirements, verify insurance information, order medical records, review original claim coding, compile supporting documentation, and submit appeals in accordance with payer requirements and company processes.
Communicate collection status with franchise partners and other departments, and resolve payer issues and concerns promptly.
Document case activity, communications, and correspondence in the computer system, maintain complete and accurate account records, 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 so they understand therapy costs before service begins.
Contribute billing expertise to the design 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.