InfuSystem ยท 4 months ago
RCM Wound Care Claim Denial Specialist
United States
Full-time
Remote
Senior Level
5+ years expInfuSystem is a leading national health care service provider, facilitating outpatient care for durable medical equipment manufacturers and health care providers. The RCM Wound Care Claim Denial Specialist is responsible for managing third party payer collections, performing accounts receivable management, and filing appeals for medical necessity and benefit coverage.
Health CareMedical Device
Responsibilities
Monitor accounts receivable agings to ensure timely resolution of claims
Ability to identify and report any trends causing future potential denials
Ensure payment accuracy
Learn and assist with Collection processes for all business line or as assigned
Must be able to interpret payer explanation of benefits (EOBs)
Review payer denials, analyze accounts, and determine the next appropriate steps to achieve payment success
This will include payer portal review and phone calls to payers. Successful candidates will have the ability to clearly and concisely communicate the issues that they are seeing and request payer representatives to assist with resolution
Conduct insurance reverification as needed through various eligibility tools
Research, write, and submit appeals as appropriate
Process third party payer correspondence, refunds, and adjustments
Accurately and thoroughly document the pertinent collections activities in appropriate systems
Possess knowledge on billing guidelines and modifiers used for Advanced Wound Care and Negative Pressure Wound Therapy
Have experience in submitting appeals for Advanced Wound Care and Negative Pressure Wound Therapy
Respond to all patient inquiries timely
Remain up to date on payer medical policy notices and changes
Share information and ideas for process improvements with team
Comply with all work instructions, policies, and behavioral expectations
Performs other related duties as assigned and required
Qualification
Required
Associate degree or equivalent preferred; minimum five years related experience; or equivalent combination of education and experience
Organizational skills
Good troubleshooting skills
Strong attention to detail
Proficient with Word, Excel, Outlook
Operate Express/HDMS/Waystar proficiently
Understanding of insurance guidelines including Medicare, Medicaid, Workers Compensation, and all Commercial managed-care plans
Ability to handle inquiries and respond via telephone or in writing
Ability to explain and resolve collections-related questions/issues to patients, sales representatives, and facilities
Proper use of ICD-10, CPT, and HCPCS codes
Ability to independently meet tight deadlines in a project-based atmosphere
Strong work ethic
Sound judgment
Proven written and verbal communication skills
Natural curiosity to pursue issues and increase expertise
Passionate about InfuSystem and serving customers and patients
Strives to make an impact on improving our business processes and results
Exemplary honesty and integrity
Ability to collaborate effectively and work selflessly as part of a team
Preferred
Five years of wound care billing/collections experience preferred
Benefits
Health, Dental, Vision
Life Insurance, STD & LTD
401(k) with a specified Company Match
Employee Stock Purchase Program
Tuition Assistance
Generous Paid Time Off plan
Paid Parental Leave
Employee Assistance Program
Competitive Pay
Direct Deposit
Employee Referral Bonus
Company
InfuSystem
InfuSystem is a growing healthcare company that provides infusion pumps .
201-500 employees
Funding
Current Stage
Growth StageLeadership Team
Richard DiIorio
Chief Executive Officer & Board Member
Barry Steele
Chief Financial Officer
Recent News
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2025-11-04
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2025-11-04
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