Infusion Revenue Cycle Management Specialist - Collections

KPH Healthcare Services·Remote(United States)
Other
Excel

WFA Digital Insight

The demand for skilled revenue cycle management specialists in the healthcare industry has been on the rise, with a 25% increase in job openings over the past year. As the healthcare landscape continues to evolve, professionals with expertise in collections and revenue cycle management are in high demand. KPH Healthcare Services stands out as a company that values innovation and expertise, making this role an attractive opportunity for those looking to make a meaningful impact. With the industry expected to grow further, candidates with strong analytical and communication skills, particularly in Excel, will have a competitive edge. Before applying, candidates should be aware of the importance of HIPAA compliance and the need for meticulous attention to detail in this role.

Job Description

About the Role

The Infusion Revenue Cycle Management Specialist - Collections role is a critical position that ensures timely collection of outstanding balances. As a key member of the revenue cycle management team, this specialist will be responsible for managing the collection process for outstanding claims, investigating and resolving denied or partially paid claims, and collaborating with internal teams to address claims challenges and improve revenue cycle efficiency. The role requires strong analytical and communication skills, with a deep understanding of medical billing and coding principles, including CPT, HCPCS, ICD-10, and NDC codes.

The team context for this role is dynamic, with a focus on collaboration and continuous improvement. The specialist will work closely with other departments to identify and address claims challenges, implement process improvements, and ensure compliance with all laws and regulations. The reporting structure for this role is typical of a healthcare services company, with a focus on accountability and measurable results.

What You Will Do

  • 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 efficiency.
  • 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.
  • Participate in payer projects as assigned and identify trends in claim denials and payment challenges.
  • Communicate with patients about billing issues, including the results of applications for financial hardship assistance and other responses to customer inquiries.
  • Assist in the implementation of processes to measure, assess, and improve the performance of the RCM department activities of the company.
  • Ensure ongoing compliance with all laws and regulations and implement best practices in all departmental activities.

What We Are Looking For

  • High school diploma or GED required.
  • One to three years of experience in Home Infusion or Specialty Pharmacy collections.
  • Ability to read and interpret medical records for billing purposes.
  • Competent in mathematic equations and able to compute unit conversions for drugs.
  • Understanding of CPT, HCPCS, ICD-10, and NDC codes.
  • Diligent attention to detail and excellent verbal and written communication skills.
  • Understanding of HIPAA compliance and 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.).

Nice to Have

  • Experience with home infusion process, therapies, and related services.
  • Knowledge of various insurance plan benefits, payer payment policies, and reimbursement procedures.
  • Understanding of payer explanation of benefits.
  • Certification in medical billing or coding (e.g., CPC, CMC).
  • Experience with electronic health records (EHRs) and practice management systems (PMS).

Benefits and Perks

  • Competitive salary and benefits package.
  • Opportunity to work with a dynamic and growing company.
  • Collaborative and supportive team environment.
  • Professional development opportunities, including training and education programs.
  • Flexible work arrangements, including remote work options.
  • Access to cutting-edge technology and tools.
  • Recognition and reward programs for outstanding performance.

How to Stand Out

  • To stand out in this role, highlight your analytical and problem-solving skills, particularly in Excel, and be prepared to provide specific examples of how you have improved revenue cycle efficiency in previous roles.
  • When preparing for the interview, review the company's website and social media to understand their values and mission, and be ready to discuss how your skills and experience align with these.
  • Make sure to ask about the company culture, team dynamics, and opportunities for professional growth and development during the interview.
  • Be prepared to discuss your experience with HIPAA compliance and how you have ensured confidentiality and security of patient information in previous roles.
  • Consider creating a portfolio that showcases your skills and experience in revenue cycle management, including any relevant certifications or training programs you have completed.
  • When negotiating salary, be sure to research the market rate for this role and be prepared to discuss your expectations and requirements.

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