Collections Specialist

Summary

Coral Connect is a technology-enabled healthcare services provider focused on reducing costs through intelligent data management, pharmacy optimization, and value-driven sourcing. The Collections Specialist will manage accounts receivable for pharmacy and ambulatory infusion services, resolve payer and patient account issues, work claims and denials, submit appeals, and support reporting and reconciliation activities.

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

Skills

• * High school diploma or equivalent required
• * 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
• Remote with limited travel to client locations, internal business meetings, and other locations as needed
• * 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
• Bachelor's degree or relevant experience is preferred

Qualifications

Must Haves

• * High school diploma or equivalent required
• * 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
• Remote with limited travel to client locations, internal business meetings, and other locations as needed

Nice to Haves

• * 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
• Bachelor's degree or relevant experience is preferred

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• Life insurance
• 401(k)
• Paid time off
• Remote work