Major Medical Collector HYBRID

Qualifications

• Minimum 5 years of experience in medical collections, with specific knowledge of home health and/or specialty pharmacy billing.
• Strong INFUSION pharmacy background
• Strong understanding of Medicare, Medicaid, and commercial insurance payor processes.
• Experience with claim denials, appeals, and reimbursement procedures for home health services and specialty medications.
• Proficiency with medical billing systems, electronic health records (EHR), and pharmacy benefit systems. CPR +, (Mediware) and/or Caretend software is a plus
• Excellent organizational, analytical, and problem-solving skills.
• Strong communication skills with the ability to interact professionally with patients, payors, and internal staff.

Responsibilities

• Review and reconcile Accounts Receivable (A/R) reports to track and manage outstanding balances.
• Participate in productivity calls to provide updates on collection status and goals.
• Submit appeals or correct claims assigned to payors, ensuring accuracy and compliance with home health and specialty pharmacy requirements.
• Answer incoming calls from patients, payors, and internal teams, addressing billing inquiries and claim issues.
• Follow up on appeals and corrected claims to secure resolution and payment.
• Prepare and maintain correspondence with assigned payors, documenting communication and progress.
• Conduct targeted collections efforts for specialty pharmacy claims, including high-cost medications and therapies.
• Actively participates in the Oso’s process improvement program.