Infusion Revenue Cycle Management Specialist - Collections

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    "datePosted": "2025-02-15T05:00:00.000Z",
    "description": "<h2>Overview</h2>\n<p>The Revenue Cycle Management Specialist- Collections responsibility is to ensure timely collection of outstanding balances. </p>\n<h2>Responsibilities</h2>\n<ul>\n <li>Manage the collection process for outstanding claims, including contacting insurance companies, patients, and other responsible parties via phone, email, and written correspondence. </li>\n <li>Investigate and resolve denied or partially paid claims, identifying root causes and implementing corrective actions.</li>\n <li>Collaborate with internal teams to address claims challenges and improve revenue cycle. </li>\n <li>Escalate complex or uncollectible accounts to management for further action. </li>\n <li>Submit appeals/claim corrections as needed within timely filing limits. </li>\n <li>Utilize billing software to maintain accurate and detailed records of all collection activities, including communication with payers and patients. </li>\n <li>Payer projects as assigned. </li>\n <li>Identify and report trends in claim denials and payment challenges. </li>\n <li>Communicate as needed with patients about billing issues, including the results of applications for financial hardship assistance and other responses to customer inquiries about </li>\n <li>Support accurate and comprehensive record-keeping to ensure up-to-date information is maintained and effectively shared across departments. </li>\n <li>Assist in the implementation of processes to measure, assess, and improve the performance of the RCM department activities of the company.</li>\n <li>Ensure ongoing compliance with all laws and regulations; ensure that the department meets or exceeds accreditation standards; and implement \"best practices\" in all departmental </li>\n <li>Participate in surveys conducted by authorized inspection </li>\n <li>Participate in the company's Performance Improvement program as requested by the Performance Improvement </li>\n <li>Participate in company committees when </li>\n <li>Participate in in-service education programs provided by the company.</li>\n <li>Pursue continuing education programs appropriate to job </li>\n <li>Perform other duties as assigned by </li>\n <li>Complete all mandatory and regulatory training programs.</li>\n <li>Report any misconduct, suspicious or unethical activities to the Compliance </li>\n <li>Complies with accepted professional standards and practice.</li>\n</ul>\n<h2>Qualifications</h2>\n<p><strong>Job Skill Requirements:</strong></p>\n<ul>\n <li>Ability to read and interpret medical records for billing purposes. </li>\n <li>Competent in mathematic equations. </li>\n <li>Ability to compute unit conversions for drugs.</li>\n <li>Understanding of CPT, HCPCS, ICD-10, and NDC codes </li>\n <li>Diligent attention to detail.</li>\n <li>Excellent verbal and written communication. </li>\n <li>Understanding of HIPAA compliance. </li>\n <li>Self-directed, has the ability to work with little supervision.</li>\n <li>Proficiency in Excel, Outlook, and all other office applications.</li>\n <li>Familiarity with pharmacy management systems (CPR+, Wellsky, and CareTend, etc.)</li>\n <li>Understanding of various insurance plan benefits, payer payment policies, and reimbursement procedures. </li>\n <li>Deep understanding of home infusion process, therapies, and related services. </li>\n <li>Ability to understand payer explanation of benefits.</li>\n</ul>\n<p><strong>Educational Requirements:</strong></p>\n<ul>\n <li>High school diploma or GED</li>\n</ul>\n<p><strong>Experience:</strong></p>\n<ul>\n <li>One to three years of experience in Home Infusion or Specialty Pharmacy collections. </li>\n</ul>\n<p> </p>",
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