Collections Specialist

Position: Collections Specialist - Pharmacy & AIC Infusion

Company Bio:

Coral Connect, LLC ("Coral") is a technology-enabled service provider focused on reducing healthcare costs through intelligent data management, pharmacy optimization, and value-driven sourcing. Our mission is to make specialty care more accessible, efficient, and equitable by improving operations at community care organizations, infusion centers, and specialty providers.

Job Overview:

The Collections Specialist for Pharmacy and Ambulatory Infusion Center (AIC) is responsible for managing outstanding accounts receivable, ensuring timely reimbursement, and resolving payer and patient account issues. This role focuses on specialty pharmacy and infusion claims, requiring a strong understanding of complex billing, payer guidelines, and reimbursement methodologies.

Responsibilities:

Your key responsibilities will include:

• Manage and follow up on assigned accounts receivable for pharmacy and AIC infusion services
• Work denied, rejected, and underpaid claims to ensure maximum reimbursement
• Contact insurance payers to resolve claim issues, verify claim status, and secure payment
• Review Explanation of Benefits (EOBs) and Electronic Remittance Advice (ERAs) to identify discrepancies
• Investigate and resolve billing errors, coding issues, and authorization-related denials
• Submit appeals and supporting documentation as needed
• Monitor aging reports and prioritize accounts based on timely filing limits and reimbursement impact
• Collaborate with billing, coding, intake, and clinical teams to resolve claim issues
• Identify trends in denials or payer behavior and escalate systemic issues
• Maintain accurate documentation of all collection activities in the system
• Ensure compliance with payer requirements, HIPAA regulations, and company policies
• Assist with patient account inquiries, including balance questions and payment arrangements (as applicable)
• Support month-end reporting and AR reconciliation activities

Qualifications:

To excel in this role, you should possess the following qualifications:

• High school diploma or equivalent required
• 1-2 years of experience in medical collections, preferably in specialty pharmacy or infusion services preferred
• Knowledge of infusion billing, specialty drug reimbursement, and HCPCS/J-codes preferred
• Strong understanding of payer guidelines, appeals processes, and denial management
• Experience with EHR/Practice Management systems (e.g., WeInfuse, CareTend, Brightree, or similar)
• Proficiency in Microsoft Excel and reporting tools
• Strong analytical and problem-solving skills
• Excellent communication and negotiation abilities
• Attention to detail and accuracy
• Ability to manage a high-volume workload and meet deadlines
• Critical thinking and persistence in resolving complex claims
• Team-oriented with the ability to work independently

Education:

Bachelor's degree or relevant experience is preferred.

License Requirement: N/A

Job Benefits:

Health, Dental, Vision, Life, 401k, Paid Time Off.

Location:

Remote with limited travel to client locations, internal business meetings, and other locations as needed.