Collections Specialist

About This Role

This Collections Specialist role focuses on managing accounts receivable for pharmacy and ambulatory infusion center (AIC) services. It involves ensuring timely reimbursement and resolving payer and patient account issues, requiring a strong understanding of complex billing and reimbursement methodologies for specialty pharmacy and infusion claims.

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

Requirements

• High school diploma or equivalent required
• 1-2 years of experience in medical collections, preferably in specialty pharmacy or infusion services
• 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 have:

• Bachelor

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• Life insurance