We are a growing home infusion pharmacy dedicated to providing exceptional patient care while maintaining the highest standards of billing accuracy and reimbursement. The Medical Collections Specialist is responsible for managing and resolving outstanding insurance claims, following up with commercial, Medicare, and Medicaid payers, appealing denied claims, and ensuring timely reimbursement.
This role focuses on home infusion and specialty pharmacy collections in a fast-paced revenue cycle environment. The ideal candidate can work independently, maintain accurate documentation in CPR+, and help maximize reimbursement while supporting quality patient care.
Essential responsibilities
- Follow up on outstanding insurance claims to ensure prompt payment.
- Investigate and resolve claim denials, rejections, and underpayments.
- Prepare and submit first- and second-level appeals.
- Work directly with insurance companies to resolve claim issues.
- Review EOBs, ERAs, and payer correspondence.
- Identify billing errors and coordinate corrections with the billing team.
- Maintain accurate documentation of all collection activities within CPR+.
- Monitor aging reports and prioritize accounts for follow-up.
- Meet departmental productivity and collection goals.
- Maintain compliance with HIPAA and all applicable payer regulations.
- Collect outstanding insurance balances for home infusion and specialty pharmacy claims.
- Follow up with Medicare, Medicaid, and commercial insurance carriers regarding unpaid, denied, and underpaid claims.
- Analyze EOBs, ERAs, payer correspondence, and denial reasons.
- Prepare and submit first-level, second-level, and external appeals.
- Resolve authorization, medical necessity, coding, coordination of benefits, and timely filing issues.
- Research payer policies and identify opportunities for additional reimbursement.
- Work closely with billing, intake, authorization, pharmacy, and clinical staff to resolve claim issues efficiently.
- Prioritize aged accounts to maximize cash collections.
- Meet or exceed monthly productivity and collection goals while maintaining quality standards.
- Ensure compliance with HIPAA, Medicare, Medicaid, and payer guidelines.
Required qualifications
- Minimum of 2 years of medical collections experience in a home infusion pharmacy or specialty pharmacy.
- Hands-on experience with CPR+ software is required.
- Strong knowledge of Medicare, Medicaid, and commercial insurance reimbursement.
- Experience appealing denied claims and resolving complex billing issues.
- Knowledge of HCPCS, CPT, ICD-10, modifiers, and medical necessity requirements.
- Excellent communication, organization, and problem-solving skills.
- Ability to manage multiple priorities while meeting deadlines.
- Proficiency with Microsoft Office applications, particularly Excel and Outlook.
Preferred qualifications
- Home infusion pharmacy experience is strongly preferred.
- Experience with Waystar or other medical claims clearinghouses.
- Knowledge of infusion therapy billing and reimbursement.
- Familiarity with payer portals and electronic claim status systems.
Additional experience preferred
- Claims collection experience for IVIG, biologic therapies, autoimmune disease infusions, neurology infusions, rheumatology infusions, gastroenterology infusions, oncology supportive care, and specialty injectable medications.
Benefits and perks
- Competitive salary based on experience
- Paid time off
- Paid holidays
- Health insurance
- 401(k) with company match
- Opportunities for professional growth and advancement
- Supportive, team-oriented work environment
- Flexible schedule
- Health savings account
- Parental leave
- Retirement plan
- Referral program
Location
California, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
2 weeks ago