Medical Insurance Collections Specialist

AIS Healthcare is the leading provider of Targeted Drug Delivery (TDD) and Infusion Care solutions. Guided by our core values of Innovation, Stewardship, and Unity, we are committed to Advancing Quality and Improving Lives for the patients, providers, and communities we serve.

We are seeking an experienced Medical Insurance Collection Specialist to join our Financial Services team. This role is ideal for a healthcare collections professional who enjoys resolving complex reimbursement issues, managing denials and appeals, analyzing payer payments, and maximizing insurance reimbursement.

If you are looking for a remote opportunity with a company that values collaboration, accountability, and professional growth, we would love to hear from you.

The Medical Insurance Collection Specialist is responsible for managing collection activities related to Targeted Drug Delivery (TDD) services. This includes reimbursement follow-up, denial management, appeals, payment investigation, account resolution, and working directly with insurance carriers and other responsible parties to ensure timely payment for services rendered.

The ideal candidate will possess strong healthcare collections experience, an in-depth understanding of insurance reimbursement processes, and the ability to independently resolve complex account issues while ensuring compliance with federal, state, payer, and company requirements.

• Follow up on submitted claims and invoices to ensure prompt and accurate reimbursement
• Investigate and resolve denied, underpaid, unpaid, duplicate, and overpaid claims
• Analyze payments and denials for accuracy and proper application
• Research and resolve billing and reimbursement discrepancies
• Initiate and manage appeals to maximize reimbursement opportunities
• Process account adjustments, write-offs, and refund requests according to company policies
• Collaborate with internal departments to obtain information necessary for payment resolution
• Maintain detailed documentation of collection activities and insurance carrier communications
• Contact insurance companies to troubleshoot payment issues and establish resolution
• Resolve denial issues within established turnaround times
• Ensure compliance with HIPAA, federal regulations, payer requirements, and company policies
• Identify opportunities to improve reimbursement and reduce outstanding accounts receivable
• Maintain knowledge of insurance plans, medical terminology, billing procedures, government regulations, and medical codes
• Develop a working knowledge of NDC numbers, metric quantities, and infusion-related supplies
• Share knowledge and best practices with team members to support overall department success

• High School Diploma or GED
• 3–5 years of healthcare industry experience
• 3–5 years of medical billing and insurance collections experience
• Strong understanding of healthcare reimbursement and collection processes
• Experience with denial management and appeals
• Ability to analyze and resolve complex reimbursement issues
• Knowledge of insurance plans, medical terminology, billing procedures, and healthcare regulations
• Excellent verbal and written communication skills
• Strong attention to detail and organizational skills
• Ability to work independently in a remote environment
• Proficiency in Microsoft Outlook, Word, and Excel

• Home Infusion experience
• Intrathecal Pain Management experience
• Specialty Pharmacy experience
• Experience working with infusion therapies and reimbursement models
• Knowledge of NDC numbers and infusion-related supplies
• Understanding of payer contracts and reimbursement methodologies

To be considered for this position, you must complete the Culture Index Assessment.

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AIS Healthcare is the nation's leading provider of advanced sterile, patient-specific intrathecal pump medications and in-home infusion therapies. Through innovative pharmacy services, specialized nursing support, and comprehensive care coordination, we help providers deliver exceptional patient care and outcomes.

We're looking for positive, hardworking professionals who are passionate about making a difference in the lives of patients and providers.