Collections Specialist

Summary

Vital Care Infusion Services is a pharmacy franchise business providing home infusion services through locally owned pharmacies and clinics across the United States. The Collections Specialist performs home infusion claims collection and revenue cycle duties, including reviewing denials, pursuing insurer and patient balances, submitting appeals, investigating benefits, and documenting account activity to improve collection rates and reduce bad debt.

Responsibilities

• Review claims with outstanding balances and identifies actions to successfully collect revenues. Follow up with insurers and patients to collect outstanding balances in an environment focused on building enduring customer and business relationships. Utilize Payer Portals via the internet for claim disposition
• Review documents received including Explanations of Benefits (EOBs), Remittance Advices (RAs), and other documents indicating denials or claims acceptance. Identify reasons for denials, take required corrective action, and take ownership of claims through to timely, successful collection
• Analyze denials, identify trends, and recommend process improvement opportunities that will result in DSO reduction, superior collection rate, intervals reduced bad debt and simplified processes that are responsive to the requirements of specific payers
• Identify payor requirements for submittal of appeals for denied claims. Verify insurance information with patients, order medical records, review original claim coding, compile other validating documentation required, and submit appeals in keeping with payor requirements and VCI processes
• Communicate effectively with franchise partners and other VCI departments regarding the status of collections. Resolve payer issues/concerns timely
• Document case activity, communications, and correspondence in the computer system to ensure completeness and accuracy of account activity and actions are taken to resolve outstanding claims issues. Schedule follow-ups in required intervals
• Investigate and verify benefits for pharmacy and medical third-party claims
• Communicate billing problems found during collection process as to avoid the same issues in the future
• Communicate financial obligation information with patients so that they have a clear understanding of all costs of therapy prior to starting service
• Contribute medical billing expertise to the design of training and knowledge transfer programs, materials, policies, and procedures to improve the efficiency and effectiveness of the RCM team. Assist with the processing of online adjudication of collection issues and nurse billing as assigned
• Perform other related duties as assigned

Skills

• 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
• 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
• Sitting: Prolonged periods of sitting are typical, often for the majority of the workday
• Keyboarding: Frequent use of a keyboard for typing and data entry
• Reaching: Occasionally reaching for items such as files, documents, or office supplies
• Fine Motor Skills: Precise movements of the fingers and hands for tasks like typing, using a mouse, and handling paperwork
• Visual Acuity: Good vision for reading documents, computer screens, and other detailed work
• Vital Care is a U.S.-based employer and hires only individuals who are authorized to work in the United States and who perform their work from within the United States
• Applicants and employees must accurately disclose their current work location and work authorization status during the application and hiring process
• Previous remote work environment is a plus but not required
• Detailed oriented with post-billing and post-payment investigative experience preferred

Qualifications

Must Haves

• 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
• 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
• Sitting: Prolonged periods of sitting are typical, often for the majority of the workday
• Keyboarding: Frequent use of a keyboard for typing and data entry
• Reaching: Occasionally reaching for items such as files, documents, or office supplies
• Fine Motor Skills: Precise movements of the fingers and hands for tasks like typing, using a mouse, and handling paperwork
• Visual Acuity: Good vision for reading documents, computer screens, and other detailed work
• Vital Care is a U.S.-based employer and hires only individuals who are authorized to work in the United States and who perform their work from within the United States
• 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

Benefits

• Comprehensive medical, dental, and vision plans, plus 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 and tuition reimbursement.
• Employee assistance programs include mental health, financial and legal.
• Rewards programs offered by our medical carrier.
• Professional development and growth opportunities.
• Employee Referral Program.
• 100% remote position.