The Collections Specialist performs duties to collect Home Infusion claims, focusing on accuracy, timeliness, and adherence to processes to reduce denial rates, DSO, and bad debt. This role involves recognizing additional revenue opportunities and improving collection rates, performing revenue cycle collection duties within standard or accepted practice limits.
Responsibilities
Review claims with outstanding balances and identify 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
Requirements
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
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Tailored applications submitted
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
High School Diploma and additional specialized training in intake, pharmacy/medical billing, and/or collections
Nice to have:
Previous remote work environment is a plus
Detailed oriented with post-billing and post-payment investigative experience
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
Income protection programs include company-sponsored basic life insurance and long-term disability insurance, as well as 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
Important Details
Schedule: Prolonged periods of sitting are typical, often for the majority of the workday; frequent use of a keyboard for typing and data entry; occasionally reaching for items such as files, documents, or office supplies; precise movements of the fingers and hands for tasks like typing, using a mouse, and handling paperwork; good vision for reading documents, computer screens, and other detailed work
About the Company
Vital Care is the premier pharmacy franchise business with franchises serving a wide range of patients, including those with chronic and acute conditions. Since 1986, their passion has been improving the lives of patients and healthcare professionals through locally-owned franchise locations across the United States. They have over 100 franchised Infusion pharmacies and clinics in 35 states, focusing on the underserved and secondary markets. Vital Care is committed to creating an inclusive, growth-focused environment where every voice matters.
