Billing Specialist: Remote opportunity

The Billing Specialist is responsible for verifying that all appropriate prescription reimbursement data has been obtained, entered into the system and is accurate weekly and prior to month end. Processes electronic pharmacy insurance claims to Medicare D, Medicaid, and Commercial Insurance. Assures the timely and accurate submission of invoices to the responsible payer for services and products provided, and evaluates payments received for final resolution and application to the patient account.

QUALIFICATION REQUIREMENTS

• It will be added as a distinct advantage for the candidate having 5+ years of past working experience in collection related activities.
• Previous home infusion therapy billing experience, a plus.
• Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.
• Basic level skill in Microsoft Office (including Word, Excel, PowerPoint, etc.).
• Willing to travel up to 5% of the time for business purposes, if required (when necessary to attend meetings, conferences, seminars, etc.)
  
  

QUALIFICATIONS PREFERRED

• High school diploma or equivalent, college credits or degree preferred.
  
  

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Process all credit card payments
• Submits all Individual Specialized Contract claims
• Electronic pharmacy billing
• Assure that accounts remain profitable with processing Profitability Reports.
• Maintain accurate financial charting in billing notes and reimbursement patient record.
• Respond appropriately to changes in patients clinical and reimbursement status.
• Assure that all bills are submitted accurately according to accepted billing practices.
• Searching each financial statement for any payment inconsistencies or errors
• Collaborating with patients or customers, third party institutions and other team members to resolve billing inconsistencies and errors
• Consistently demonstrates behavior that complies with the BioMatrix compliance philosophy.
• Employee will act in accordance with all applicable federal and state laws and with the highest ethical standards that we consistently strive to achieve. Thus, legal and ethical compliance is an essential duty of each employee.
• Will participate in legal and ethical compliance training each year.
• Will consistently behave in compliance with the BioMatrix’s legal and ethical policies and procedures.
• Will abide by the policies of BioMatrix as set forth in the Compliance Manual.
• Will not participate in any conduct considered to be unethical or illegal.

Authorization Activities:

• Verify current eligibility and obtain authorization for Medicaid on a back-up basis.
• Verify current eligibility and obtain authorization for Pharmacy Plans on a backup basis.
• Create written documentation trail for all verification, authorization, approval and communications that will affect reimbursement on a case.

Collections Activities:

• Communicate with payer on follow-up status of claims.
• Identify stage of payment (i.e. receiving, processing, approval, auditing or payment).
• Communicate any changes in the process or policy that may affect future payment success.
• Problem resolution on pricing or processing issues.

NON-ESSENTIAL FUNCTIONS & RESPONSIBILITIES

• Strong working knowledge of medical terminology.
• Strong knowledge of HCPCS, ICD 9, and CPT coding.
• Strong skills in electronic billing.
• Strong knowledge of reimbursement requirements for all insurance payers including Medicare, Medicaid, Medicare D, Commercial and pharmacy plans.
• Strong calculation/math skills.
• Ability to prioritize and handle multiple tasks and projects concurrently.
• Must have scheduling flexibility and be able to work overtime.
• Overnight travel on occasion by car or airplane.
• Careful attention to detail.
• Performs related duties as requested.
• Participates in quality assurance activities and audits as directed.

KNOWLEDGE, SKILLS AND ABILITIES REQUIREMENTS

• Able to stay abreast of payer alerts and reimbursement changes.
• Able to work in a fast-paced environment.
• Able to navigate and interpret insurance contracts.
• Ability to actively communicate, inspire and motivate all levels of staff.
• Ability to think and act strategically and proactively.
• Ability to maintain accurate records and prepare reports and correspondence related to the work.
• Ability to organize and coordinate the work of others.
• Ability to set priorities and assign work to other professionals.
• Excellent analytical skill.

Communication Skills

• Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
• Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

Computer Skills

• Become and remain proficient is all programs necessary for execution.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

• This position requires constant sitting with occasional walking, standing, kneeling or stooping.
• This position requires the use of hands to finger, handle or feel objects and the ability to reach with hands and arms.
• This position requires constant talking and hearing.
• Specific vision abilities required by this job include close vision and the ability to adjust focus.
• This position must occasionally lift and/or move up to 20 pounds
• Required to move/lift physical hardware.
  
  

AMERICANS WITH DISABILITY SPECIFICATIONS

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.