Collections specialist - rcm

Recognized as a “Best Place to Work Modern Healthcare” – Join a team where people come first. At Vital Care, we are committed to creating an inclusive, growth-focused environment where every voice matters.

Vital Care is the premier pharmacy franchise business with franchises serving a wide range of patients, including those with chronic and acute conditions. Since 1986, our passion has been improving the lives of patients and healthcare professionals through locally-owned franchise locations across the United States. We have over 100 franchised Infusion pharmacies and clinics in 35 states, focusing on the underserved and secondary markets. We know infusion services, and we guide owners along the path of launch, growth, and successful business operations.

What we offer:

• Comprehensive medical, dental, and vision plans, plus flexible spending, and health savings accounts.
• Paid time off, personal days, and company-paid holidays.
• Paid Paternal Leave.
• Volunteerism Days off.
• Income protection programs include company-sponsored basic life insurance and long-term disability insurance, as well as employee-paid voluntary life, accident, critical illness, and short-term disability insurance.
• 401(k) matching and tuition reimbursement.
• Employee assistance programs include mental health, financial and legal.
• Rewards programs offered by our medical carrier.
• Professional development and growth opportunities.
• Employee Referral Program.

Job Summary:

Perform duties to collect Home Infusion claims, focusing on accuracy, timeliness, and adherence to processes to reduce denial rate, DSO, and bad debt. Recognize additional revenue opportunities and improve collection rates; perform revenue cycle collection duties within standard or accepted practice limits.

This position is 100% remote

Duties/Responsibilities:

• Review claims with outstanding balances and identifies actions to successfully collect revenues. Follow up with insurers and patients to collect outstanding balances in an environment focused on building enduring customer and business relationships. Utilize Payer Portals via the internet for claim disposition.
• Review documents received including Explanations of Benefits (EOBs), Remittance Advices (RAs), and other documents indicating denials or claims acceptance. Identify reasons for denials, take required corrective action, and take ownership of claims through to timely, successful collection.
• Analyze denials, identify trends, and recommend process improvement opportunities that will result in DSO reduction, superior collection rate, intervals reduced bad debt and simplified processes that are responsive to the requirements of specific payers.
• Identify payor requirements for submittal of appeals for denied claims. Verify insurance information with patients, order medical records, review original claim coding, compile other validating documentation required, and submit appeals in keeping with payor requirements and VCI processes.
• Communicate effectively with franchise partners and other VCI departments regarding the status of collections. Resolve payer issues/concerns timely.
• Document case activity, communications, and correspondence in the computer system to ensure completeness and accuracy of account activity and actions are taken to resolve outstanding claims issues. Schedule follow-ups in required intervals.
• Investigate and verify benefits for pharmacy and medical third-party claims.
• Communicate billing problems found during collection process as to avoid the same issues in the future.
• Communicate financial obligation information with patients so that they have a clear understanding of all costs of therapy prior to starting service.
• Contribute medical billing expertise to the design of training and knowledge transfer programs, materials, policies, and procedures to improve the efficiency and effectiveness of the RCM team. Assist with the processing of online adjudication of collection issues and nurse billing as assigned.
• Perform other related duties as assigned.

Required Skills/Abilities:

• Excellent communications skills; listening, speaking, understanding, and writing English while influencing patients, caregivers, payer representatives, and others, answering questions, and advancing reimbursement and collection efforts.
• Proven understanding of processes, systems, and techniques to ensure successful billing and collection working with all payer types.
• Proven ability to identify gaps and problems from the review of documentation, determine lasting solutions, make effective decisions, and take necessary corrective action.
• Strong organization skills with the ability to track and maintain clear, complete records of activities, cases, and related documentation.
• Proven knowledge and skill in the utilization of MS Office suite of software and pharmacy applications.
• Ability to complete job duties in a designated workspace outside the dedicated RCM location.
• Disciplined work ethic with ability to work remotely with minimum direct supervision, to effectively meet production and collection targets.

Education and Experience:

• 2-5 years home infusion billing and/or collections experience required.
• High School Diploma and additional specialized training in intake, pharmacy/medical billing, and/or collections.
• Previous remote work environment is a plus but not required.
• Detailed oriented with post-billing and post-payment investigative experience preferred.

Physical Requirements:

• Sitting: Prolonged periods of sitting are typical, often for the majority of the workday.
• Keyboarding: Frequent use of a keyboard for typing and data entry.
• Reaching: Occasionally reaching for items such as files, documents, or office supplies.
• Fine Motor Skills: Precise movements of the fingers and hands for tasks like typing, using a mouse, and handling paperwork.
• Visual Acuity: Good vision for reading documents, computer screens, and other detailed work.

Be part of an organization that invests in you! We are reviewing applications for this role and will contact qualified candidates for interviews.

Vital Care Infusion Services is an equal-opportunity employer and values diversity at our company. We do not discriminate on the basis of color, race, sex, age, religion, national origin, disability, genetic information, gender identity, sexual orientation, veterans’ status, or any other basis protected by applicable federal, state, or local law.

Vital Care is a U.S.-based employer and hires only individuals who are authorized to work in the United States and who perform their work from within the United States. Applicants and employees must accurately disclose their current work location and work authorization status during the application and hiring process. Any material misrepresentation or omission regarding identity, location, work authorization, qualifications, or other employment-related information may result in withdrawal of a job offer, immediate termination of employment, and pursuit of any remedies available under applicable law.

Vital Care Infusion Services participates in E-Verify.

This position is full-time and remote. The salary range for this position is $18.92-$23.46/hr.

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