We are seeking a tenacious, results-driven Insurance Collections Specialist to join a rapidly growing nationwide specialty and home infusion pharmacy team at our brand-new Plano, TX office.
This role requires a unique combination of grit, problem-solving skills, and deep expertise in healthcare insurance collections. You will manage and resolve outstanding claims while navigating the complex reimbursement landscape of home infusion and specialty pharmaceuticals-specifically Immunoglobulin (IG) therapies.
If you thrive in a collaborative yet independent environment, enjoy solving complex billing puzzles, and possess a "bulldog" mentality when advocating for claim resolution, this is the perfect opportunity to accelerate your revenue cycle career.
Collections & Accounts Receivable
Proactively manage an assigned aging portfolio of insurance claims across commercial, Medicare, Medicaid, and managed care payers.
Conduct timely, assertive follow-ups on unpaid, denied, or underpaid claims via telephone, payer portals, and written correspondence.
Identify and resolve claim edits, rejections, and denials related to prior authorization, eligibility, coding, or medical necessity.
Denial Management & Appeals
Analyze root causes of complex denials and underpayments; prepare and submit effective first-level and second-level appeals with supporting clinical and coding documentation.
Partner with internal pharmacy teams to obtain necessary medical records, physician attestations, or supporting documentation for appeals.
Track appeal activity within the EMR system and escalate high-dollar or complex denials to leadership as needed.
Payer & Reimbursement Expertise
Navigate both medical benefit (Part B, commercial medical) and pharmacy benefit (Part D, specialty PBM) claim pathways.
Utilize working knowledge of HCPCS, NDC, modifiers, and revenue codes applicable to infusion therapy and specialty pharmacy.
Stay informed on payer policy updates, billing guidelines, and CMS regulations impacting reimbursement.
Documentation & Compliance
Maintain accurate, thorough notes in the EMR system for all account actions.
Spot systemic billing trends or issues and communicate them to leadership to drive process improvements.
Strictly adhere to HIPAA regulations and federal/state compliance standards regarding protected health information (PHI).
Experience: 2-3+ years of experience in healthcare insurance collections or accounts receivable.
Specialized Knowledge: Direct experience in home infusion, specialty pharmacy, or Immunoglobulin (IG) therapy billing/collections is strongly preferred.
Payer Expertise: Demonstrated ability to work with major payers including Medicare, Medicaid, PBMs, and commercial insurance.
Billing Systems: Familiarity with pharmacy/medical billing platforms such as CareTend, CPR+, or Waystar.
Technical Skills: Proficiency in Microsoft Office Suite, particularly Microsoft Excel.
Key Attributes: High resilience, exceptional organizational skills, ability to manage high-volume workloads, and a dedicated, investigative approach to resolving unpaid claims.
100% Onsite: Work out of a brand-new office facility in Plano, TX. The schedule will be Monday - Friday 8:30 am to 5 pm.
Entrepreneurial Spirit: Experience the stability of an established, high-revenue organization paired with the agility, urgency, and feel of a fast-paced team.
Patient-First Focus: Work within a supportive culture that values dedication, empathy, and high performance in serving patient care needs
For California Applicants:
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).
This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. 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.
