Collections Specialist

PARKVIEW HEALTH SERVICES LLC - 3.4

Buffalo, NY Job Details Full-time $25 - $30 an hour 14 hours ago Qualifications High school diploma or GED Negotiation Full Job Description The Collections Specialist is responsible for proactive, persistent follow-up on pharmacy accounts receivable to ensure timely reimbursement from third-party payers, PBMs, and patients. This role focuses primarily on collections and denial resolution, with limited AR support activities that directly facilitate collection success. Primary Responsibilities Actively pursue overdue pharmacy claims and outstanding balances through payer portals, phone calls, written correspondence, and electronic follow-ups. Conduct timely and persistent follow-up on unpaid, underpaid, and denied claims with PBMs, commercial payers, Medicaid, Medicare, and other third-party insurers. Investigate and resolve payment delays, non-payments, and discrepancies, including reversals, recoupments, and short pays. Identify trends in non-payment or denial patterns and escalate issues appropriately. Manage assigned AR worklists by payer and aging category, prioritizing high-dollar and high-risk accounts. Ensure appeals are initiated when warranted and monitored through final resolution. Document all collection activity thoroughly and accurately in the billing system. Support audit readiness by maintaining clean, well-documented account activity. Perform targeted AR research to support collection resolution (e.g., verifying claim status, payment application accuracy, or payer requirements). Review EOBs and remittance advice to identify underpayments and payment variances relevant to collection efforts. Collaborate with billing, intake, and pharmacy operations teams to address root causes impacting collection outcomes. Communicate clearly with internal teams regarding recurring payer issues, system barriers, or operational gaps affecting collections. Monitor and contribute to key AR and collection performance metrics, including aging, denial rates, and recovery rates. Perform other related duties as assigned. Key Skills Familiarity with payer portals, EOBs, denial codes, and appeal processes. Demonstrated experience working AR aging greater than 60 days and resolving complex balances. Excellent communication, negotiation, and problem-solving skills. High attention to detail with strong organizational and time-management abilities. Education/Experience Requirements High school diploma or equivalent. Minimum 2-3 years of collections and/or pharmacy AR experience. Strong knowledge of pharmacy billing, PBMs, and third-party reimbursement. Experience with specialty pharmacy, infusion pharmacy, or high-dollar pharmacy claims with knowledge of Medicare Part B, Part D, and Medicaid pharmacy billing strongly preferred.