Revenue Cycle Management - Collections Specialist

Vital Care Infusion Services•Monroeville, PA

1d•Remote

About The Position

The Revenue Cycle Management - Collections Specialist performs collections for Home Infusion claims, focusing on accuracy, timeliness, and adherence to established processes to reduce denial rates, days sales outstanding (DSO), and bad debt. The role identifies additional revenue opportunities and works to improve collection rates within standard or accepted practices. This is a full-time, 100% remote position. The specialist reviews claims with outstanding balances, follows up with insurers and patients, uses payer portals, and examines explanations of benefits, remittance advices, and other claim documents. They investigate denials, take corrective action, prepare and submit appeals, and manage claims through successful collection. The role also documents account activity, communicates with franchise partners and internal departments, investigates benefits, and helps identify and prevent recurring billing issues. The specialist may contribute billing expertise to training and process materials 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 while advancing reimbursement and collections.
Demonstrated understanding of processes, systems, and techniques for successful billing and collection 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 related documentation.
Knowledge and skill in using Microsoft Office software and pharmacy applications.
Ability to perform 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.
Attention to detail 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 building enduring customer and business relationships.
Use payer portals to check claim disposition.
Review explanations of benefits, remittance advices, and other documents showing claim acceptance or denial.
Identify denial reasons, take corrective action, and manage claims through timely, 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 requirements for appeals of denied claims.
Verify insurance information with patients, order medical records, review original claim coding, compile supporting documentation, and submit appeals according to payer requirements and company processes.
Communicate collection status to franchise partners and other company departments.
Resolve payer issues and concerns in a timely manner.
Document case activity, communications, correspondence, and actions 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 their recurrence.
Explain patients' financial obligations so they understand therapy costs before services begin.
Contribute medical billing expertise to the design 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.
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.