Collections Specialist

Coral Connect LLC•Boca Raton, FL

8d•Remote

About The Position

The Collections Specialist for Pharmacy and Ambulatory Infusion Center (AIC) is responsible for managing outstanding accounts receivable, ensuring timely reimbursement, and resolving payer and patient account issues. This role focuses on specialty pharmacy and infusion claims, requiring a strong understanding of complex billing, payer guidelines, and reimbursement methodologies.

Requirements

High school diploma or equivalent required
1-2 years of experience in medical collections, preferably in specialty pharmacy or infusion services preferred
Knowledge of infusion billing, specialty drug reimbursement, and HCPCS/J-codes preferred
Strong understanding of payer guidelines, appeals processes, and denial management
Experience with EHR/Practice Management systems (e.g., WeInfuse, CareTend, Brightree, or similar)
Proficiency in Microsoft Excel and reporting tools
Strong analytical and problem-solving skills
Excellent communication and negotiation abilities
Attention to detail and accuracy
Ability to manage a high-volume workload and meet deadlines
Critical thinking and persistence in resolving complex claims
Team-oriented with the ability to work independently

Nice To Haves

Bachelor’s degree or relevant experience is preferred.

Responsibilities

Manage and follow up on assigned accounts receivable for pharmacy and AIC infusion services
Work denied, rejected, and underpaid claims to ensure maximum reimbursement
Contact insurance payers to resolve claim issues, verify claim status, and secure payment
Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs) to identify discrepancies
Investigate and resolve billing errors, coding issues, and authorization-related denials
Submit appeals and supporting documentation as needed
Monitor aging reports and prioritize accounts based on timely filing limits and reimbursement impact
Collaborate with billing, coding, intake, and clinical teams to resolve claim issues
Identify trends in denials or payer behavior and escalate systemic issues
Maintain accurate documentation of all collection activities in the system
Ensure compliance with payer requirements, HIPAA regulations, and company policies
Assist with patient account inquiries, including balance questions and payment arrangements (as applicable)
Support month-end reporting and AR reconciliation activities