Identify root cause of issues and demonstrate recommendations for corrective action steps to eliminate future occurrences of denials.
Identify trends or payment challenges and take action to support resolution and prevent future issues.
Process all Payer appeal requests within the time limit required by the Payer.
Processes rejections and denials to determine if the claim needs to be refiled or submitted for an appeal with the payer.
Reviews patient information in appropriate system to determine why the claim is unpaid, if an adjustment is valid, and whether additional approval is required.
Identify errors, correct claims, and reprocess for reimbursement.
Review claim processing to determine proper payment has been issued.
Accurately identify adjustments needed and take proper action to prevent further adjustments.
Submission of claims investigations and reviewing payer contracts for reimbursement.
Communication with patients, payors, outside agencies, and public through telephone, electronic and written correspondence.
Review and analyze reports to track account activity and highlight opportunities for improvement.
Ensure all work meets quality assurance and benchmark standards set by the management team.
Work independently and as part of a team.
Documents all collections activity in patient collections notes and AR Reports.

High school diploma or equivalent.
1+ year of experience in home infusion medical and/or pharmacy billing practices
Knowledge of Microsoft 365 products, including but not limited to Outlook, Teams, and Excel.
Excellent interpersonal, organizational, communication and effective critical thinking skills.
Experience with ICD-10, CPT-4, HCPCS, and medical terminology.
Familiarity with third party payor guidelines and reimbursement practices and available financial resources for payment of balances due.
Maintain confidentiality and practice discretion and caution when handling sensitive information.
Ability to read and interpret an EOB for accurate understanding of claim processing.

Collections Specialist

Key skills