Collections Specialist - RCM

Duties/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.
• Affix other related duties as assigned.

Required Skills/Abilities

• 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.

Education and Experience

• 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.
• Previous remote work environment is a plus but not required.
• Detailed oriented with post-billing and post-payment investigative experience preferred.