Collections Specialist

The Collections Specialist is responsible for proactive, persistent follow-up on pharmacy 
accounts receivable to ensure timely reimbursement from third-party payers, PBMs, and 
patients. This role focuses primarily on collections and denial resolution, with limited AR support 
activities that directly facilitate collection success. 
Primary Responsibilities 
• Actively pursue overdue pharmacy claims and outstanding balances through payer 
portals, phone calls, written correspondence, and electronic follow-ups.
• Conduct timely and persistent follow-up on unpaid, underpaid, and denied claims with 
PBMs, commercial payers, Medicaid, Medicare, and other third-party insurers.
• Investigate and resolve payment delays, non-payments, and discrepancies, including 
reversals, recoupments, and short pays. Identify trends in non-payment or denial patterns 
and escalate issues appropriately.
• Manage assigned AR worklists by payer and aging category, prioritizing high-dollar and 
high-risk accounts.
• Ensure appeals are initiated when warranted and monitored through final resolution.
• Document all collection activity thoroughly and accurately in the billing system. Support 
audit readiness by maintaining clean, well-documented account activity.
• Perform targeted AR research to support collection resolution (e.g., verifying claim status, 
payment application accuracy, or payer requirements).
• Review EOBs and remittance advice to identify underpayments and payment variances 
relevant to collection efforts.
• Collaborate with billing, intake, and pharmacy operations teams to address root causes 
impacting collection outcomes. Communicate clearly with internal teams regarding 
recurring payer issues, system barriers, or operational gaps affecting collections.
• Monitor and contribute to key AR and collection performance metrics, including aging, 
denial rates, and recovery rates.
• Perform other related duties as assigned.
 

Key Skills
• Familiarity with payer portals, EOBs, denial codes, and appeal processes.
• Demonstrated experience working AR aging greater than 60 days and resolving complex 
balances.
• Excellent communication, negotiation, and problem-solving skills.
• High attention to detail with strong organizational and time-management abilities.

Education/Experience Requirements
• High school diploma or equivalent. 
• Minimum 2–3 years of collections and/or pharmacy AR experience.
• Strong knowledge of pharmacy billing, PBMs, and third-party reimbursement.
• Experience with specialty pharmacy, infusion pharmacy, or high-dollar pharmacy claims
with knowledge of Medicare Part B, Part D, and Medicaid pharmacy billing strongly 
preferred.
 

Salary : $25 - $30