Reimbursement Counselor
MMC Group
San Bruno, CA
Reimbursement Counselor
MMC Group
San Bruno, CA
Expired: over a month ago
Applications are no longer accepted.
- $20 Hourly
- Full-Time
Job Description
Company Info
Job Description
Reimbursement Coordinator
San Bruno, CA
$19.50/HR
Hours: 7:00 AM - 4:00 PM Monday - Friday
POSITION SUMMARY:
Under the general supervision of the Reimbursement Supervisor / Manager, is responsible for various reimbursement functions, including but not limited to accurate and timely claim submission, claim status, collection activity, appeals, payment posting, and/or refunds, until accounts receivable issues are properly resolved.
PRIMARY DUTIES AND RESPONSIBILITIES:
- Completing/Conducting Benefit Investigations
- Completing Prior Authorizations and determining best approach for a PA process
- Transferring Cases to Specialty Pharmacies
- Follow-up Calls to Insurances
- Conducting Alternative Coverage searches
- Creating letters of medical necessity
- Drafting appeal letters
- Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program
- Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications
- Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payors. Researches and resolves any electronic claim denials
- Researches and resolves any claim denials or underpayment of claims
- Effectively utilizes various means for collections, including but not limited to phone, fax, mail, and online methods
- Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly
- Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers
- Reports any reimbursement trends/delays to supervisor (e.g. billing denials, claim denials, pricing errors, payments, etc.)
- Processes any necessary insurance/patient correspondence
- Provides all necessary documentation required to expedite payments. This includes demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians
- Coordinates with inter-departmental associates to obtain appropriate medical records as they relate to the reimbursement process
- Maintains confidentiality in regards to patient account status and the financial affairs of clinic/corporation
- Communicates effectively to payors and/or claims clearinghouse to ensure accurate and timely electronically filed claims
- Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action
- Typically receives little instruction on day-to-day work, general instructions on new assignments
- Performs related duties as assigned
MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:
- Must have recently experience with Health Insurance
- Ability to communicate effectively both orally and in writing
- Ability to build productive internal/external working relationships
- Strong interpersonal skills
- Strong negotiating skills
- Strong mathematical skills
- Strong organizational skills; attention to detail
- General knowledge of accounting principles, pharmacy operations, and medical claims
- General knowledge of HCPCS, CPT, ICD-9 and ICD-10 coding preferred
- Global understanding of commercial and government payers preferred
- Ability to proficiently use Microsoft Excel, Outlook and Word
- Is developing professional expertise; applies company policies and procedures to resolve a variety of issues
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