Collections Specialist - Revenue Cycle Management

Vital Care Infusion Services•Jacksonville, FL

8d•Remote

About The Position

Vital Care is seeking a Collections Specialist to join their Revenue Cycle Management team. This role focuses on collecting Home Infusion claims with accuracy and timeliness to reduce denial rates, DSO, and bad debt. The specialist will identify revenue opportunities, improve collection rates, and perform revenue cycle collection duties. The position is 100% remote and emphasizes building strong customer and business relationships while adhering to payer requirements and company processes.

Requirements

2-5 years home infusion billing and/or collections experience required.
High School Diploma and additional specialized training in intake, pharmacy/medical billing, and/or collections.
Excellent communications skills; listening, speaking, understanding, and writing English while influencing patients, caregivers, payer representatives, and others, answering questions, and advancing reimbursement and collection efforts.
Proven understanding of processes, systems, and techniques to ensure successful billing and collection working with all payer types.
Proven ability to identify gaps and problems from the review of documentation, determine lasting solutions, make effective decisions, and take necessary corrective action.
Strong organization skills with the ability to track and maintain clear, complete records of activities, cases, and related documentation.
Proven knowledge and skill in the utilization of MS Office suite of software and pharmacy applications.
Ability to complete job duties in a designated workspace outside the dedicated RCM location.
Disciplined work ethic with ability to work remotely with minimum direct supervision, to effectively meet production and collection targets.
Applicants and employees must accurately disclose their current work location and work authorization status during the application and hiring process.

Nice To Haves

Previous remote work environment is a plus but not required.
Detailed oriented with post-billing and post-payment investigative experience preferred.

Responsibilities

Review claims with outstanding balances and identify actions for successful revenue collection.
Follow up with insurers and patients to collect outstanding balances.
Utilize Payer Portals via the internet for claim disposition.
Review documents such as Explanations of Benefits (EOBs) and Remittance Advices (RAs) to identify claim acceptance or denials.
Identify reasons for denials, take corrective action, and ensure timely collection of claims.
Analyze denials, identify trends, and recommend process improvements to reduce DSO, improve collection rates, reduce bad debt, and simplify processes.
Identify payor requirements for submitting appeals for denied claims.
Verify insurance information with patients, order medical records, review original claim coding, compile validating documentation, and submit appeals.
Communicate effectively with franchise partners and other VCI departments regarding collection status.
Resolve payer issues/concerns in a timely manner.
Document case activity, communications, and correspondence in the computer system.
Schedule follow-ups at required intervals.
Investigate and verify benefits for pharmacy and medical third-party claims.
Communicate billing problems found during the collection process to prevent future issues.
Communicate financial obligation information with patients.
Contribute medical billing expertise to the design of training and knowledge transfer programs, materials, policies, and procedures.
Assist with the processing of online adjudication of collection issues and nurse billing as assigned.
Perform other related duties as assigned.