Reimbursement Specialist Medical Collector - Laguna Hills, United States - AmeriPharma

AmeriPharma

Verified Company

Laguna Hills, United States

2 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

Mission Statement

Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients.

It is our joint and individual responsibility daily to demonstrate to outpatients, prescribers, colleagues, and others that
We Care

AmeriPharma is a rapidly growing company where you will have the opportunity to contribute to our joint success on a daily basis.

We value new ideas, creativity, and productivity.

We like people who are passionate about their roles and people who like to grow and change as the company evolves.

At AmeriPharma, you'll have access to:

Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
Great pay and general compensation structures
Employee assistance program to assist with mental health, legal questions, financial counseling etc.
Comprehensive PTO and sick leave options
401k program
Plenty of opportunities for growth and advancement
Company sponsored outings and teambuilding events
Casual Fridays

Job Summary

As a Reimbursement Specialist/Medical Collector at AmeriPharma, you will be responsible for accurate and timely claims reimbursement activities, including interactions with third party payers and patients as well as maintaining accurate records.

Duties and Responsibilities

Reviews patient inventory of assigned accounts
Reviews accuracy of claims submitted and communicates to team members and management on any process inefficiencies and billing errors resulting in claim denials and underpayments
Verifies newly submitted claims status to ensure that claims are on file with insurance, in process, and hold payers accountable for accurate and timely reimbursement
Reviews accuracy of claim payments received from payers and patients
Identify and communicate to the management team in a timely manner on inadequate reimbursement rates that may require a pharmacy transfer
Submits appeals and pursues additional payments on any medical claims denied in error or paid less than the expected reasonable maximum allowable rate for the procedure codes submitted and level of patient's benefit coverage
Submits letter of negotiations and obtain payment resolutions from claim payers
Performs collections on patient balances ensuring maximum reimbursement for all services provided
Ensures submission of complete and appropriate clinical documentation when justifying claims medical necessity
Independently perform claims followup and collections activities such as resolving claims denials and rejections through claim resubmissions, corrected claims and appeals in compliance with Billing Department's approved reimbursement strategies in a timely manner
Effectively review and interpret benefits details and Identify and communicate on any inaccuracies in benefit details affecting claims reimbursement
Document detailed claim status on each patient's account (new or otherwise) accurately and in a timely manner
Creates and utilizes reminders and follow up reports to ensure completion of any incomplete or pending activities
Escalates to management on any unresolved claim issues after proper claim resolution attempts that have been made
Maintains a positive DSO on assigned account inventory
Provides the highest level of customer service in answering patient phone calls and resolve patients' questions and/or billing issues, as well as communicate with doctors' offices and their staff
Identifies and communicates to the management team on any incomplete or inaccurate billing related databases resulting in billing errors and process delays in a timely manner
Ensures compliance with all payer rules and regulations
Ensures compliance with all company policies and procedures
Other duties as assigned

Required Skills:

Ability to read, write, speak, and understand the English language
Collaborate and cooperate with other team members and management for all Pharmacy needs
Excellent time management, communication, interpersonal, multitasking, and prioritization skills
Strong interpersonal skills
Ability to support colleagues in a fastchanging environment, collaborative, service oriented, social perceptiveness
Ability to work independently with mínimal guidance
Ability to type with mínimal errors
Ability to read, comprehend, analyze, and interpret data
Ability to work the hours that will ensure all projects and duties are completed in a timely manner

Education Requirements

High School Diploma
Experience as a medical coder/biller with a working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement
Knowledge of ICD 10, CPT, HCPC, J billing codes and medical terminology
Knowledge of Government Appeals, and submission guidelines
Knowledge of reimbursement appeal strategies and claims escalations
Knowledge of automated billing systems and CMS HCFA 1500 form
Advanced kn