Collections Specialist

Caretend Experience Required

Position Summary

We are seeking a Collections Specialist to support Coral Connect’s pharmacy and infusion revenue cycle operations. This position focuses on resolving outstanding insurance accounts, recovering appropriate reimbursement, and moving unpaid claims through to resolution.

The ideal candidate has practical collections experience and can confidently use Caretend to investigate account balances, review claim history, document follow-up, and identify the next action needed to secure payment. Experience limited to intake, test claims, or basic system navigation will not meet the needs of this position.

Key Responsibilities

• Own an assigned accounts receivable portfolio and follow unpaid pharmacy and infusion claims through resolution.
• Investigate payment delays through payer portals and direct contact with insurance representatives.
• Use Caretend to research account activity, track outstanding issues, and maintain clear follow-up notes.
• Evaluate denials and partial payments, determine the cause, and coordinate the appropriate correction or escalation.
• Prepare reconsiderations and appeals with supporting records within payer deadlines.
• Interpret remittance information and distinguish between contractual adjustments, unresolved insurance balances, and patient responsibility.
• Prioritize work according to account age, balance, filing deadlines, and recovery opportunity.
• Partner with billing, intake, authorization, and clinical staff to obtain information needed for payment.
• Flag recurring reimbursement problems and communicate patterns to leadership.
• Handle patient balance questions when assigned, following approved procedures and escalation guidelines.
• Meet established productivity and quality expectations while protecting confidential information.

Required Qualifications

• High school diploma or equivalent.
• At least two years of healthcare insurance collections or accounts receivable follow-up experience.
• Hands-on Caretend experience supporting billing, reimbursement, or collections workflows.
• Demonstrated experience pursuing unpaid claims—not solely submitting claims or performing patient intake.
• Ability to explain the actions taken to resolve a denied, delayed, or underpaid claim.
• Working knowledge of insurance reimbursement, payer follow-up, appeals, and timely filing requirements.
• Ability to interpret EOBs and ERAs and accurately document account resolution activity.
• Strong communication, organization, and problem-solving skills.
• Comfortable using Excel, payer websites, and multiple applications while managing an assigned workload.

Preferred Qualifications

• Collections experience in home infusion, specialty pharmacy, or an ambulatory infusion center.
• Familiarity with medical and pharmacy benefit reimbursement.
• Knowledge of HCPCS/J-codes, modifiers, drug units, and authorization requirements relevant to infusion claims.
• Experience resolving older accounts receivable and identifying recurring denial causes.

What Success Looks Like

• Accounts receive consistent follow-up with a clear next step.
• Recoverable balances move toward payment before deadlines expire.
• Documentation allows another team member to understand the account without repeating the investigation.
• Complex issues reach the appropriate person promptly.
• Work meets the team’s established standards for accuracy, productivity, and reimbursement recovery.