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Medical Biller/Collections Specialist Home Infusion – Remote – Remote

To perform this job successfully, an individual must be able to perform the essential functions of this position satisfactorily but are not necessarily limited to the following:

· Responsible for medical billing and collections of IVIG, Biologics and Hemophilia claims in addition to other company specific therapies on CPR+ platform

· Researches proper billing policies and procedures of all payors to ensure correct billing of claims. Researches all denials and completes all corrections, resubmissions and adjustments accurately and timely.

· Verifies that payments received are correct and according to companies fee schedules, and that claims are processsed correctly against billing and industry standards and regulations, and match our contract agreements with individual providers.

· Follows up on reimbursement research and communications and reqired appeals in an efficient and timely manner.

· Efficiently utilizes all functions of the company’s software(CPR+) applications, including maintaining accurate and detailed charts and notes.

· Clearly, accurately and concisely document notes in medical software system per company guidelines and to meet all HIPAA requirements.

· Effectively identify and communicate to Manager and team leads when assistance is needed (including, but not limited to, system function and training).

· Observes legal and ethical guidelines of HIPAA for safeguarding patient and company confidential and proprietary information.

· Consistently provides exceptional customer service for, and effectively communicates with, clients, patients, payers and coworkers.

· Exhibits a positive, courteous, respectful and helpful attitude to clients, co-workers, and management team.

· Understands and achieves team and individual goals.

· Promotes company culture by adhering to all policies and procedures set by our company standards as well as those required by our URAC and Joint Commission Accredidations.

· Welcomes constructive feedback and makes every effort to improve and continue to expand knowledge by participating in coaching and team building activies.

· This is a flexible position and is subject to change based on the Company’s needs. Other duties may be required.

TYPICAL WORKING CONDITIONS:

This is a remote position.

TYPICAL PHYSICAL DEMANDS:

May sit, stand, stoop, bend and walk intermittently during the day. May sit or stand seven (7) to ten (10) hours per day. May be necessary to work extended hours as needed, based on the needs of the pharmacy. Manual finger dexterity needed to use calculator, keyboard and other office equipment. Must be knowledgeable in software, hardware and networks. Must be a critical thinker and problem solver with great attention to detail. Excellent people skills and communication required. Answer multi-line telephone system.

QUALIFICATIONS:

· High school diploma or GED required. College degree preferred

· 3-5 years Specialty Pharmacy-Home Infusion Medical Billing and Collections Experience

Prior knowledge of CPR + is preferred.

High level of self motivation and excellent time management skills required.

· Requires great communication skills, ability to set goals and be focused on achievement, as well as have a determined approach to all situations and be creative in assesment of issues and finding appropriate solutions.

· Capable to review and understand all areas of claims billing, processing and reimbursement/collections and must have a high level of ability to deal with complex claims issues. Experience with EOBs as well as all forms of insurance communication documents. Ability to complete appeals competently for successful overturn of negative decisions. Must be able to professionally communicate both verbally and through written coorespondence with physicians offices, nurses, internal departments, insurance companies and patients when needed.

· Extensive knowledge of HCPC coding

· Extensive knowledge of JCodes

· Extensive knowledge of CPT Codes

· Extensive Insurance Experience interacting with Medicare, Medicaid and Part D plans as well as commercial insurance and private insurance.

· Infusion Suite billing experience is preferred. As well as experience with Home Infusion billing. Experience with therapy specific billing is desired.

RESPONSIBILITIES:

· Using extensive experience of medical billing, medical claims processing and reimbursement skills our medical biller/collector will bill claims, monitor processing, and then review all negative claim decisions for accuracy and provide corrections and resumbmissions expediently when possible.

· An in-depth knowledge of the Home Infusion and Specialty Pharmacy industry will allow our medical biller/collector to assist our intake and billing departments as needed to solve claims issues and analyze possibilities they can enact to streamline processes and implement any changes that will impact reoccurring issues. All RCM positions are team oriented for overall success.

· The ability to learn and understand medical billing protocol and reimbursement issues. Regular review of all A/R reports required as well as complete understanding of the priority of consistency with follow up and communication with management to alert them of any possible concerns with specific insurance situations.

· A demonstrated ability to apply excellent verbal and written communication skills will be used daily in this position. Clear and concise delivery of information whether verbal or written is necessary to be expedient with the handling of the daily duties required.

· Responsibility of meeting metrics of job performance is required. Individual and team metrics are used to develop our company continually to higher levels of patient/provider satisfaction as well as meet and exceed our contractural requirements.

· An applied knowledge of problem-solving skills and the ability to find and implement solutions to correct a situation is required. Communication between teams to share knowledge and expertise will build a strong group focus and develop our ability to have a higher ratio of clean from the start claims.

· A demonstrated ability to prioritize, multitask, organize and utilize time efficiently. The ability to self motivate is a top requirement for this remote position.

· The initiative to learn and apply newly acquired skills, as well as using creative thinking to approach new solutions for complex and continuing issues is a responsibility of the position.

· The ability to perform duties with minimal supervision and remain on task until completion, showing a determination to succeed in obtaining a positive outcome for the A/R issue in questions is an expectation of the position.

· The ability and desire to work as a contributing team member is desired for all employees, thus allowing us to build a strong and focused, fully competent team in all departments.

· Must be highly motivated and skilled in negotiation of contracts and fully capable of providing alternative options when discussing claims outcomes. Guidance will be given but this is proactive position and the employee is responsible to make adjustment and agreements based on instructions given, policies, best judgement for most successful end results and creating a positive platform with the insurance company for any future issues.

· The position requires employee to implement and monitor policies and procedures when needed. Awareness of changing policies and procedures with our payors is required, so that we have a consistently clear understanding of requirements and specifics per insurance and per the therapy and drug in question. A desire for consistent continuing education available through multiple resources including industry bulletines, insurance payor communications and webinars, and an awareness of medical billing and reimbursement issues, policies, changes and updates will be necessary to maintain best practices and consistent success for the team.

· Our Biller/Collector will need the ability to develop billing fee schedules in addition to expected fee schedules. An ability to effectively create reports and provide information as needed is expected of the position.

What we offer:

· Competitive Pay

· Competitive Benefit Package

Note:

· 90 Day Probationary Period

· Applicant must pass background check and pre-employment drug screen.

Job Type: Full-time, salaried position. This position is fully remote.

Job Type: Full-time

Pay: $23.00 – $29.00 per hour

Benefits:

  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Disability insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance
  • Work from home

Schedule:

  • 8 hour shift
  • Monday to Friday

COVID-19 considerations:
We follow local and CDC guidance on continueing COVID protocols. The wearing of masks, safe distancing, hand washing, continuing sanitization, employee wellness checks are required.

Experience:

  • medical billing: 3 years (Preferred)
  • home infusion collections: 3 years (Preferred)

Work Location:

Work Location: Remote

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