Collections Specialist

Key Responsibilities

• Own an assigned accounts receivable portfolio and follow unpaid pharmacy and infusion claims through resolution.
• Investigate payment delays through payer portals and direct contact with insurance representatives.
• Use Caretend to research account activity, track outstanding issues, and maintain clear follow-up notes.
• Evaluate denials and partial payments, determine the cause, and coordinate the appropriate correction or escalation.
• Prepare reconsiderations and appeals with supporting records within payer deadlines.
• Interpret remittance information and distinguish between contractual adjustments, unresolved insurance balances, and patient responsibility.
• Prioritize work according to account age, balance, filing deadlines, and recovery opportunity.
• Partner with billing, intake, authorization, and clinical staff to obtain information needed for payment.
• Flag recurring reimbursement problems and communicate patterns to leadership.
• Handle patient balance questions when assigned, following approved procedures and escalation guidelines.
• Meet established productivity and quality expectations while protecting confidential information.

Required Qualifications

• High school diploma or equivalent.
• At least two years of healthcare insurance collections or accounts receivable follow-up experience.
• Hands-on Caretend experience supporting billing, reimbursement, or collections workflows.
• Demonstrated experience pursuing unpaid claims—not solely submitting claims or performing patient intake.
• Ability to explain the actions taken to resolve a denied, delayed, or underpaid claim.
• Working knowledge of insurance reimbursement, payer follow-up, appeals, and timely filing requirements.
• Ability to interpret EOBs and ERAs and accurately document account resolution activity.
• Strong communication, organization, and problem-solving skills.
• Comfortable using Excel, payer websites, and multiple applications while managing an assigned workload.

Preferred Qualifications

• Collections experience in home infusion, specialty pharmacy, or an ambulatory infusion center.
• Familiarity with medical and pharmacy benefit reimbursement.
• Knowledge of HCPCS/J-codes, modifiers, drug units, and authorization requirements relevant to infusion claims.
• Experience resolving older accounts receivable and identifying recurring denial causes.

What Success Looks Like

• Accounts receive consistent follow-up with a clear next step.
• Recoverable balances move toward payment before deadlines expire.
• Documentation allows another team member to understand the account without repeating the investigation.
• Complex issues reach the appropriate person promptly.
• Work meets the team’s established standards for accuracy, productivity, and reimbursement recovery.