Collections Specialist - Revenue Cycle Management
About The Position
Vital Care is hiring a full-time, fully remote Collections Specialist to perform Home Infusion claim collections within Revenue Cycle Management. The role focuses on accurate and timely collection, following established processes to reduce denials, days sales outstanding (DSO), and bad debt. The specialist identifies additional revenue opportunities, improves collection rates, and performs collection duties within standard or accepted practice limits. The position works with insurers, patients, franchise partners, and internal departments to resolve outstanding balances and payer issues. It includes reviewing claim and payment documents, investigating denials, verifying benefits and insurance information, preparing appeals, maintaining complete account records, and communicating patients’ financial obligations. The specialist may also contribute billing expertise to training and process improvement efforts and assist with online adjudication 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 and advance reimbursement and collection efforts.
- 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 and skill 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, with 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 and use payer portals to check claim disposition.
- Review EOBs, remittance advices, and other documents; identify denial reasons, take corrective action, and manage claims through 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 appeal requirements; verify patient insurance, order medical records, review claim coding, compile supporting documentation, and submit appeals according to payer requirements and company processes.
- Communicate collection status with franchise partners and internal departments, and resolve payer issues and concerns promptly.
- Document account 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 identified 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 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.
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.
- Company-sponsored basic life insurance and long-term disability insurance; employee-paid voluntary life, accident, critical illness, and short-term disability insurance.
- 401(k) matching.
- Tuition reimbursement.
- Employee assistance programs for mental health, financial, and legal support.
- Rewards programs offered by the medical carrier.
- Professional development and growth opportunities.
- Employee referral program.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
