Collections Specialist

Recognized as a “Best Place to Work Modern Healthcare” – Join a team where people come first. At Vital Care, we are committed to creating an inclusive, growth-focused environment where every voice matters.

Vital Care is the premier pharmacy franchise business with franchises serving a wide range of patients, including those with chronic and acute conditions. Since 1986, our passion has been improving the lives of patients and healthcare professionals through locally‑owned franchise locations across the United States. We have over 100 franchised Infusion pharmacies and clinics in 35 states, focusing on the underserved and secondary markets.

We know infusion services, and we guide owners along the path of launch, growth, and successful business operations.

• Comprehensive medical, dental, and vision plans, plus flexible spending, and health savings accounts.
• Paid time off, personal days, and company‑paid holidays.
• Paid Paternal Leave.
• Volunteerism Days off.
• Income protection programs include company‑sponsored basic life insurance and long‑term disability insurance, as well as employee‑paid voluntary life, accident, critical illness, and short‑term disability insurance.
• 401(k) matching and tuition reimbursement.
• Employee assistance programs include mental health, financial and legal.
• Rewards programs offered by our medical carrier.
• Professional development and growth opportunities.
• Employee Referral Program.

Perform duties to collect Home Infusion claims, focusing on accuracy, timeliness, and adherence to processes to reduce denial rate, DSO, and bad debt. Recognize additional revenue opportunities and improve collection rates; perform revenue cycle collection duties within standard or accepted practice limits.

• Review claims with outstanding balances and identify actions to successfully collect revenues. Follow up with insurers and patients to collect outstanding balances in an environment focused on building enduring customer and business relationships. Utilize Payer Portals via the internet for claim disposition.
• Review documents received including Explanations of Benefits (EOBs), Remittance Advices (RAs), and other documents indicating denials or claims acceptance. Identify reasons for denials, take required corrective action, and take ownership of claims through to timely, successful collection.
• Analyze denials, identify trends, and recommend process improvement opportunities that will result in DSO reduction, superior collection rate, intervals reduced bad debt and simplified processes that are responsive to the requirements of specific payers.
• Identify payor requirements for submittal of appeals for denied claims. Verify insurance information with patients, order medical records, review original claim coding, compile other validating documentation required, and submit appeals in keeping with payor requirements and VCI processes.
• Communicate effectively with franchise partners and other VCI departments regarding the status of collections. Resolve payer issues/concerns timely.
• Document case activity, communications, and correspondence in the computer system to ensure completeness and accuracy of account activity and actions are taken to resolve outstanding claims issues. Schedule follow‑ups in required intervals.
• Investigate and verify benefits for pharmacy and medical third‑party claims.
• Communicate billing problems found during collection process as to avoid the same issues in the future.
• Communicate financial obligation information with patients so that they have a clear understanding of all costs of therapy prior to starting service.
• Contribute medical billing expertise to the design of training and knowledge transfer programs, materials, policies, and procedures to improve the efficiency and effectiveness of the RCM team. Assist with the processing of online adjudication of collection issues and nurse billing as assigned.
• Perform other related duties as assigned.

• Excellent communications skills; listening, speaking, understanding, and writing English while influencing patients, caregivers, payer representatives,…