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Salary:

Competitive, based on experience About Us We are a growing home infusion pharmacy dedicated to providing exceptional patient care while maintaining the highest standards of billing accuracy and reimbursement. We are seeking an experienced, detail-oriented Medical Collections Specialist with home infusion billing and CPR+ software experience to join our Revenue Cycle team. Position Summary The Medical Collections Specialist is responsible for managing and resolving outstanding insurance claims, following up with commercial, Medicare, and Medicaid payers, appealing denied claims, and ensuring timely reimbursement. The ideal candidate has a strong understanding of home infusion reimbursement and can work independently in a fast-paced environment. Essential Responsibilities Follow up on outstanding insurance claims to ensure prompt payment. Investigate and resolve claim denials, rejections, and underpayments. Prepare and submit first- and second-level appeals. Work directly with insurance companies to resolve claim issues. Review Explanation of Benefits (EOBs), Electronic Remittance Advices (ERAs), and payer correspondence. Identify billing errors and coordinate corrections with the billing team. Maintain accurate documentation of all collection activities within CPR+. Monitor aging reports and prioritize accounts for follow-up. Meet departmental productivity and collection goals. Maintain compliance with HIPAA and all applicable payer regulations. Collect outstanding insurance balances for home infusion and specialty pharmacy claims. Follow up with Medicare, Medicaid, and commercial insurance carriers regarding unpaid, denied, and underpaid claims. Analyze EOBs, ERAs, payer correspondence, and denial reasons. Prepare and submit first-level, second-level, and external appeals. Resolve authorization, medical necessity, coding, coordination of benefits, and timely filing issues. Research payer policies and identify opportunities for additional reimbursement. Work closely with billing, intake, authorization, pharmacy, and clinical staff to resolve claim issues efficiently. Maintain complete documentation of all collection activities in CPR+. Prioritize aged accounts to maximize cash collections. Meet or exceed monthly productivity and collection goals while maintaining quality standards. Ensure compliance with HIPAA, Medicare, Medicaid, and payer guidelines. Required Qualifications Minimum of 2 years of medical collections experience in a home infusion pharmacy or specialty pharmacy. Hands-on experience with CPR+ software is required. Strong knowledge of Medicare, Medicaid, and commercial insurance reimbursement. Experience appealing denied claims and resolving complex billing issues. Knowledge of HCPCS, CPT, ICD-10, modifiers, and medical necessity requirements. Excellent communication, organization, and problem-solving skills. Ability to manage multiple priorities while meeting deadlines. Proficiency with Microsoft Office applications, particularly Excel and Outlook. Preferred Qualifications CPR+ experience is required. Home infusion pharmacy experience is strongly preferred. Experience with Waystar or other medical claims clearinghouses. Knowledge of infusion therapy billing and reimbursement. Familiarity with payer portals and electronic claim status systems Candidates with experience collecting claims for the following therapies are highly encouraged to apply: IVIG Biologic therapies Autoimmune disease infusions Neurology infusions Rheumatology infusions Gastroenterology infusions Oncology supportive care Specialty injectable medications What We Offer Competitive salary (based on experience) Paid Time Off (PTO) Paid Holidays Health Insurance 401(k) with company match Opportunities for professional growth and advancement Supportive, team-oriented work environment Schedule Full-time Monday through Friday Day Shift Work Location On-site If you are an experienced medical collections professional with CPR+ home infusion experience and are passionate about maximizing reimbursement while supporting quality patient care, we encourage you to apply.

Job Type:

Full-time Pay:

$25.00 - $30.00 per hour

Benefits:

401(k) matching Flexible schedule Health insurance Health savings account Paid time off Parental leave Referral program Retirement plan

Experience:

Infusion Pharmacy and CPR +

Software:

2 years (Required)

Work Location:

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Find & Apply For Claims Specialist / Adjuster / Examiner Jobs in Signal Hill, California

Home Infusion Collections Specialist (CPR+ Software Experience Required)