Onsite Insurance Collections Specailist

You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking an Insurance Collection Specialist responsible for managing and resolving outstanding insurance claims to optimize revenue flow. This role involves verifying insurance information, initiating collections, and coordinating with insurance companies and relevant parties to ensure timely and accurate payments.

The Insurance Collections Specialist is responsible for managing and resolving outstanding insurance claims. This role requires a thorough understanding of the complex billing and reimbursement landscape associated with these specialties, including medical and pharmacy benefit coordination, prior authorization requirements, and payer-specific claim adjudication processes.

Essential Duties and Responsibilities

Collections & Accounts Receivable

• Portfolio Management: Proactively work an assigned aging portfolio of insurance claims across commercial, Medicare, Medicaid, and managed care payers, with a focus on home infusion services, specialty pharmacy, and IG therapies.
• Claim Follow-Up: Conduct timely follow-up on unpaid, denied, or underpaid claims via telephone, payer portals, and written correspondence.
• Issue Resolution: Identify and resolve claim edits, rejections, and denials related to authorization, eligibility, coding, or medical necessity. Identify and execute the necessary process adjustments.

Denial Management

• Appeals: Analyze root causes of denials and underpayments; initiate first-level and second-level appeals with supporting clinical and coding documentation.
• Internal Collaboration: Collaborate with pharmacy teams to obtain records, physician attestations, or other supporting documentation required for appeals.
• Documentation & Escalation: Track and document all appeal activity within the billing system; escalate complex or high-dollar denials to the appropriate team lead or management in a timely manner.

Payer & Claim Expertise

• Coding Knowledge: Apply working knowledge of HCPCS, NDC, and revenue codes applicable to infusion therapy and specialty pharmacy billing.
• Benefit Pathways: Understand and navigate both the medical benefit (Part B, commercial medical) and pharmacy benefit (Part D, specialty PBM) claim pathways.
• Regulatory Awareness: Stay current on payer policy changes, billing guidelines, and CMS regulations that impact reimbursement.

Documentation & Reporting

• Account Notes: Maintain thorough, accurate, and timely notes in the system for all account activity.
• Process Improvement: Identify systemic billing issues and communicate findings to the billing team for process improvement.

Compliance & Patient Confidentiality

• Privacy Regulations: Adhere to all HIPAA regulations and company policies regarding the handling of protected health information (PHI).
• Compliance: Conduct all collection activities in compliance with applicable federal and state regulations.

Qualification Requirements

• Provide the highest level of professionalism, responsiveness, and communication to build and maintain the maximum customer base possible.
• Strong understanding of the home infusion and specialty pharmacy revenue cycle, including prior authorization and claims adjudication.
• Working knowledge of HCPC codes, modifiers, revenue codes, and EOB/remittance interpretation.
• Familiarity with IG therapy coverage criteria and exception/appeal processes.
• Must possess the ability to multi-task and frequently change direction.
• Strong organizational skills with the ability to manage a high-volume workload and competing priorities.
• Excellent verbal and written communication skills.
• Proficiency in Microsoft Office Suite, particularly Excel.

Experience

• General Experience: Minimum 2-3 years of experience in healthcare insurance collections or accounts receivable.
• Specialty Experience: Direct experience with home infusion, specialty pharmacy, and/or IG billing/collections.
• Payer Experience: Demonstrated experience working with major payers including Medicare, Medicaid, PBM, and commercial insurance.
• Systems Experience: Working knowledge of industry-standard home infusion/specialty pharmacy billing platforms and healthcare clearinghouses.
• Must be willing to be onsite Monday - Friday 8:30 am to 5 pm in Plano, TX

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

* We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we're dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

* As a job position within our Revenue Cycle division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing financial and confidential information, handling financial and other payment data, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.