Revenue Cycle Management Specialist - Collections

KPH Healthcare Services; Oklahoma City (OK); On-site; USD 40,000 - 55,000; Full time

Job summary

A healthcare services company in Oklahoma City is seeking a Revenue Cycle Management Specialist to manage collections and ensure timely resolution of outstanding balances. The role involves investigating claim denials, collaborating with teams, and maintaining accurate records using billing software. Candidates should have a high school diploma, 1-3 years of relevant experience, and possess strong communication skills. Proficiency in Excel and understanding of the home infusion process are essential for success in this position.

Qualifications

• High school diploma or GED required.
• 1-3 years of experience in Home Infusion or Specialty Pharmacy collections.
• Ability to interpret medical records for billing purposes.

Responsibilities

• Manage the collection process for outstanding claims.
• Investigate and resolve denied or partially paid claims.
• Collaborate with internal teams to improve revenue cycle.
• Submit appeals/claim corrections as needed.
• Utilize billing software for accurate record-keeping.

Skills

Ability to read and interpret medical records for billing purposes

Competent in mathematic equations

Ability to compute unit conversions for drugs

Understanding of CPT, HCPCS, ICD-10, and NDC codes

Diligent attention to detail

Excellent verbal and written communication

Understanding of HIPAA compliance

Self-directed, works with little supervision

Proficiency in Excel, Outlook, and office applications

Familiarity with pharmacy management systems

Understanding of insurance plan benefits and reimbursement procedures

Deep understanding of home infusion process and therapies

Ability to understand payer explanation of benefits

Education

High school diploma or GED

Tools

Excel

Outlook

Pharmacy management systems (CPR+, Wellsky, and CareTend)

Job description

Overview

The Revenue Cycle Management Specialist- Collections responsibility is to ensure timely collection of outstanding balances.

Responsibilities

• Manage the collection process for outstanding claims, including contacting insurance companies, patients, and other responsible parties via phone, email, and written correspondence.
• Investigate and resolve denied or partially paid claims, identifying root causes and implementing corrective actions.
• Collaborate with internal teams to address claims challenges and improve revenue cycle.
• Escalate complex or uncollectible accounts to management for further action.
• Submit appeals/claim corrections as needed within timely filing limits.
• Utilize billing software to maintain accurate and detailed records of all collection activities, including communication with payers and patients.
• Payer projects as assigned.
• Identify and report trends in claim denials and payment challenges.
• Complete all mandatory and regulatory training programs.
• Report any misconduct, suspicious or unethical activities to the Compliance
• Complies with accepted professional standards and practice.

Qualifications

Job Skill Requirements:

• Ability to read and interpret medical records for billing purposes.
• Competent in mathematic equations.
• Ability to compute unit conversions for drugs.
• Understanding of CPT, HCPCS, ICD-10, and NDC codes
• Diligent attention to detail.
• Excellent verbal and written communication.
• Understanding of HIPAA compliance.
• Self-directed, has the ability to work with little supervision.
• Proficiency in Excel, Outlook, and all other office applications.
• Familiarity with pharmacy management systems (CPR+, Wellsky, and CareTend, etc.)
• Understanding of various insurance plan benefits, payer payment policies, and reimbursement procedures.
• Deep understanding of home infusion process, therapies, and related services.
• Ability to understand payer explanation of benefits.

Educational Requirements:

• High school diploma or GED

Experience:

• One to three years of experience in Home Infusion or Specialty Pharmacy collections.