Collections Specialist

ExactCare Pharmacy; Orlando (FL); Remote; USD 40,000 - 55,000; Full time

Job summary

A leading pharmacy is seeking a dedicated Medical Collections Specialist for their Revenue Cycle Team. This role involves collecting insurance claims, managing billing processes, and ensuring compliance with guidelines. Join a supportive team and contribute to enhancing revenue generation through effective medical billing practices.

Benefits

medical/dental/vision

flexible spending

life insurance

short-term disability

401(k)

PTO

holidays

Qualifications

• 1-3 years of related experience in a team environment.
• Collections or medical billing experience preferred.

Responsibilities

• Understand Third Party Billing and Collection Guidelines.
• Document all collection activities in patient collection notes.
• Process all payer appeal requests within required timeframes.

Skills

Effective communication

Attention to detail

Self-motivated

Knowledge of Home Infusion

Education

High school diploma or GED

Tools

ICD9

CPT4

HCPCS

HCN360

CPR+

Job description

locations FL - Remote CarepathRx Specialty Pharmacy & Infusion Solutions Locations

time type Full time

posted on Posted 2 Days Ago

job requisition id R-107154

CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services.

We are seeking a dedicated Medical Collections Specialist for our Revenue Cycle Team. In this position, you will be responsible for the collection of insurance claims.

Responsibilities

1. Understand Third Party Billing and Collection Guidelines.
2. Identify root causes of issues and recommend corrective actions to prevent future denials.
3. Meet quality assurance, benchmark standards, and maintain productivity levels as defined by management.
4. Contact payers or patients as appropriate.
5. Document all collection activities in patient collection notes.
6. Record work performed on AR Aging Reports and Over/Under Reports.
7. Process all payer appeal requests within required timeframes.
8. Handle approved adjustments.
9. Address rejections and denials to determine if claims need re-filing or appeals.
10. Review patient information to identify unpaid claims and determine if adjustments are valid and require approval.
11. Identify errors, correct claims, and reprocess for reimbursement.
12. Read and interpret EOBs for denial reasons.
13. Investigate claims and contracts for reimbursement.
14. Perform other duties as assigned.

Qualifications

• Background investigation (company-wide).
• Drug screening (if applicable).
• Valid driver's license with a clean record (if applicable).

Education & Experience

• High school diploma or GED.
• 1-3 years of related experience in a team environment.
• Experience in the medical field and administrative record management.

Skills & Abilities

• Effective communication with patients, payers, and agencies via various mediums.
• Polite, knowledgeable, and helpful attitude.
• Ability to interpret instructions across communication forms.
• Knowledge of Home Infusion, insurance policies, and billing practices.
• Maintain confidentiality and discretion.
• Ability to multitask with attention to detail.
• Basic mathematical skills.
• Self-motivated, organized, and able to work independently or in a team.
• Collections or medical billing experience with knowledge of ICD9, CPT4, HCPCS, and medical terminology preferred.
• Familiarity with payor guidelines, reimbursement, Medicare billing, and systems like HCN360 and CPR+ preferred.

CarepathRx offers a comprehensive benefits package including medical/dental/vision, flexible spending, life insurance, short-term disability, 401(k), PTO, and holidays. Coverage begins the month after hire.

Equal Employment Opportunity Statement: CarepathRx provides equal opportunity to all applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, veteran status, or other protected classes. Applicants are encouraged to self-identify. Local applicants are encouraged to apply. We maintain a drug-free environment. Eligibility to work in the country is required.