Collections Specialist - RCM

Vital Care Infusion Services•Pittsburgh, PA

2d•Remote

About The Position

Vital Care is seeking a full-time, fully remote Collections Specialist to collect Home Infusion claims accurately and promptly while following established processes to reduce denials, days sales outstanding (DSO), and bad debt. The role focuses on improving collection rates, identifying revenue opportunities, and performing revenue cycle collection work within standard practice limits. The specialist reviews and follows up on outstanding claims with insurers and patients, investigates denials, prepares appeals, verifies benefits and insurance information, and documents all account activity. The position also communicates with patients, franchise partners, payers, and internal departments; identifies recurring billing issues and process improvements; and contributes medical billing expertise to training and RCM procedures. Work is performed remotely from a designated workspace with minimal direct supervision.

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.
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 in 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.
Detail-oriented approach and post-billing and post-payment investigative experience.

Responsibilities

Review claims with outstanding balances and identify actions to collect revenue successfully.
Follow up with insurers and patients to collect balances while maintaining customer and business relationships.
Use payer portals to check claim disposition.
Review EOBs, remittance advices, and other claim acceptance or denial documents.
Identify denial reasons, take corrective action, and manage claims through timely collection.
Analyze denial trends and recommend process improvements to reduce DSO and bad debt and improve collection rates.
Identify payer appeal-submission requirements; verify insurance information, order medical records, review claim coding, compile supporting documentation, and submit appeals.
Communicate collection status with franchise partners and other VCI departments and resolve payer issues promptly.
Document case activity, communications, correspondence, and follow-up intervals in the computer system.
Investigate and verify benefits for pharmacy and medical third-party claims.
Communicate billing problems identified during collection work to help prevent recurrence.
Explain patients’ financial obligations and therapy costs before service begins.
Contribute medical billing expertise to RCM training, knowledge transfer materials, policies, and procedures.
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.
Flexible spending and health savings accounts.
Paid time off, personal days, and company-paid holidays.
Paid parental leave.
Volunteerism days off.
Company-sponsored basic life insurance and long-term disability insurance.
Voluntary life, accident, critical illness, and short-term disability insurance.
401(k) matching.
Tuition reimbursement.
Employee assistance programs for mental health, financial, and legal needs.
Rewards programs offered by the medical carrier.
Professional development and growth opportunities.
Employee referral program.