Healthcare Insurance Collections Specialist

Local Infusion is the fastest-growing infusion provider in the United States, dedicated to transforming the specialty infusion industry by delivering exceptional, patient-centered care and leveraging AI-driven technology. Their mission is to accelerate access, simplify workflows, and improve outcomes for patients, clinicians, health plans, health systems, employers, and pharma.

Clinicians benefit from reduced paperwork and more time spent with patients, fostering comfort, connection, and community in healthcare. Local Infusion ensures full support for every patient and care team throughout the infusion journey.

What We're Looking For

We are seeking a seasoned healthcare collector with the experience and judgment to manage complex, aged, and high-dollar insurance receivables. The ideal candidate will:

• Independently manage a high-volume portfolio of accounts.
• Identify the root cause of non-payment and determine the appropriate recovery pathway.
• Escalate accounts appropriately using established payer and industry-standard processes.
• Take end-to-end ownership of assigned revenue.
• Navigate payer barriers and consistently move accounts toward payment or final resolution.

What You'll Own

• Manage assigned insurance accounts receivable (AR) with a focus on aged, high-dollar, and priority revenue.
• Meet established productivity expectations while maintaining high standards of quality and accuracy.
• Perform meaningful collection activities to advance claims toward payment or final resolution.
• Research unpaid, denied, and underpaid claims to identify underlying root causes.
• Resolve denials, rejections, underpayments, authorization-related issues, eligibility issues, and other payer barriers.
• Determine the appropriate resolution pathway, including corrected claims, reconsiderations, first- and second-level appeals, payer escalations, and internal escalations.
• Follow payer-specific requirements for timely filing, reconsiderations, appeals, and dispute resolution.
• Communicate with payers to obtain claim status, processing details, call reference numbers, and next steps.
• Maintain concise, complete, and actionable account documentation.
• Establish appropriate follow-up dates and actively manage claims throughout the collection lifecycle.
• Identify recurring payer trends and systemic issues, escalating them for broader resolution.
• Partner cross-functionally with Billing, Authorization, Intake, Cash Posting, Patient Collections, and RCM leadership to resolve revenue barriers.
• Prioritize inventory based on financial exposure, aging, timely filing risk, and recovery opportunity.
• Maintain ownership of assigned inventory through payment or final disposition.

What Success Looks Like

The successful collector demonstrates consistent ownership of assigned accounts and applies sound judgment to move claims toward timely resolution. This includes:

• Conducting thorough claim research to identify the root cause of non-payment or underpayment.
• Selecting the appropriate resolution pathway based on payer requirements, claim status, and established escalation protocols.
• Maintaining complete, concise, and actionable documentation of findings, actions taken, payer responses, and next steps.
• Establishing appropriate follow-up timelines and maintaining consistent ownership through payment or final disposition.
• Recognizing when standard collection activity is no longer effective and initiating reconsiderations, appeals, payer escalations, or internal escalations.
• Identifying recurring payer or process trends and escalating systemic issues for broader resolution.
• Balancing productivity, quality, and financial impact while meeting established performance expectations.
• Demonstrating measurable contributions to aged AR reduction, cash recovery, and inventory resolution.

What You Bring

• 3+ years of healthcare insurance collections or AR follow-up experience, preferably within infusion, specialty pharmacy, physician practice, or another complex specialty environment.
• Demonstrated experience managing aged and high-dollar accounts receivable.
• Strong working knowledge of commercial and government payer processes.
• Experience resolving denials, underpayments, authorization issues, eligibility issues, and claim-processing errors.
• Working knowledge of corrected claims, reconsiderations, appeals, timely filing requirements, and payer escalation pathways.
• Ability to interpret EOBs, ERAs, payer correspondence, and claim-processing information.
• Strong account documentation and follow-up discipline.
• Ability to independently prioritize a large inventory based on risk, aging, and financial impact.
• Ability to work effectively within established productivity and quality standards.
• Strong analytical and problem-solving skills with the ability to identify trends and recognize when broader escalation is required.
• Experience with infusion or specialty medication billing and collections strongly preferred.

How We Measure Success

Success in this role is measured by both productivity and outcomes. Key performance indicators include:

• Meaningful claim activity.
• Documentation quality.
• Adherence to follow-up expectations.
• Aged AR reduction.
• Cash recovery.
• Inventory resolution.

Collectors are expected to maintain ownership of assigned accounts from initial assignment through payment or final disposition, while consistently meeting established productivity and quality expectations.