<div><strong>About the Client<br /></strong>A nationally focused clinical specialty pharmacy that provides home infusion, specialty and compounding services with a strong emphasis on personalized, community-based care. The organization is accredited and operates with rigorous compliance and HIPAA standards while serving multiple states. They prioritize timely authorizations, clinical support, and high-quality billing/reimbursement practices to ensure patients receive home-based infusion therapies.</div><div><br /><strong>Why does this role exist?<br /></strong>This role exists to accelerate and stabilize revenue collection for home infusion services by managing insurance-side billing and out-of-network claim recoveries. The specialist will reduce accounts receivable backlog, resolve denials and underpayments, and negotiate reimbursements with payers so clinical teams can focus on patient care. Hiring this specialist ensures compliant, efficient collections and improved cash flow for infusion services.</div> <h2> The Impact you’ll make </h2> <div><strong>Accounts Receivable Management</strong></div><ul><li>Monitor and manage patient and insurance accounts to ensure timely collection of outstanding balances.</li><li>Review unpaid or partially paid claims, verify billing details, and follow up with payers to secure payment.</li><li>Maintain accurate aging trackers and prioritize high-risk accounts.</li></ul><div><strong>Billing and Documentation</strong></div><ul><li>Review claims for completeness and payer compliance before resubmission.</li><li>Ensure accurate posting of payments, adjustments, and account notes in billing systems.</li><li>Maintain detailed records of collection activities, insurance communications, and follow-ups.</li></ul><div><strong>Out-of-Network Claims Management</strong></div><ul><li>Verify coverage and eligibility for out-of-network claims, obtain necessary authorizations, and prepare documentation for reimbursement requests.</li><li>Negotiate payment terms and reimbursements with insurance companies for out-of-network services.</li><li>Manage balance-billing workflows and coordinate with internal teams to determine patient responsibility (note: role focuses on insurance-side collections; no direct patient outreach).</li></ul><div><strong>Dispute Resolution &amp; Denial Management</strong></div><ul><li>Investigate claim denials or underpayments, obtain supporting clinical/billing documentation, and submit appeals or corrections as required.</li><li>Collaborate with pharmacy staff and payer representatives to resolve disputes and implement corrective actions.</li><li>Track denial reasons and recommend process improvements to reduce recurrence.</li></ul><div><strong>Reporting &amp; Compliance</strong></div><ul><li>Prepare regular AR, aging, and collections activity reports for management review.</li><li>Analyze trends (denials, payer behavior, aging) and suggest optimizations to collection processes.</li><li>Ensure all activities comply with HIPAA, payer policies, and internal billing best practices.</li></ul> <h2> Benefits </h2> <div><span>﻿</span><figure><a href="https://res.cloudinary.com/pinpointhq/image/upload/v1726318909/uploads/production/h0nvppetbg03uftd0cvc.png"><figcaption></figcaption></a></figure><span>﻿</span><span>﻿</span><figure><a href="https://res.cloudinary.com/pinpointhq/image/upload/v1726318784/uploads/production/rgwtxj4zjp1osdl44pmu.png"><figcaption></figcaption></a></figure><span>﻿</span><span>﻿</span><figure><a href="https://res.cloudinary.com/pinpointhq/image/upload/v1726318880/uploads/production/fdqtlewimsqtdsz5tb4m.png"><figcaption></figcaption></a></figure><span>﻿</span><span>﻿</span><figure><a href="https://res.cloudinary.com/pinpointhq/image/upload/v1726318892/uploads/production/g3pbqsx1ksditw8d7jrq.png"><figcaption></figcaption></a></figure><span>﻿</span><span>﻿</span><figure><a href="https://res.cloudinary.com/pinpointhq/image/upload/v1726318898/uploads/production/yfs4hzxxslvbkeuier7s.png"><figcaption></figcaption></a></figure><span>﻿</span><span>﻿</span><figure><a href="https://res.cloudinary.com/pinpointhq/image/upload/v1726318902/uploads/production/g4xvq0qahoi5wdcjecgg.png"><figcaption></figcaption></a></figure><span>﻿</span></div>

Magic

Medical Biller & Collections Specialist Freelance, Remote Support & Leadership

Magic

Similar Remote Jobs