Biller Specialist

Description

Job Summary: The reimbursement specialist is responsible for verifying that all appropriate reimbursement paperwork has been obtained, completed and is accurate prior to billing. 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.

Essential Functions:

• Understands the terms and fee schedule for all contracts for which invoices are submitted.
• Correctly determines quantities and prices for drugs billed.
• Verifies that the services and products are correctly authorized and that required documentation is on file.
• Ensures that invoices are submitted for services and products that are properly ordered and confirmed as provided.
• Verifies that payments received are correct according to the fee schedule.
• Identifies secondary balances, patient balances and transfers them accordingly to the appropriate payer.
• Identifies all bad debt write offs, and A/R adjustments. Initiates Write Off/Adjustment Form Policies and Procedures to assure appropriate documentation is attached to the request and that all levels of approval are followed per Policies and Procedures.
• Ensures that secondary bills and patient invoices are mailed according to Policies and Procedures.
• Notifies the Manager if there are overpayments and/or duplicate payments for the same service by submitting a refund request.
• Records all billing activity in the system per Policies and Procedures.
• Follow up calls to verify that claims submitted were received and are in processing.
• Takes the appropriate steps to assure correct and timely filing on all claims that are not on file with the payer after the initial billing.
• Generates and mails statements and collections letters per Policies and Procedures.
• Follows-up on all denials within 24 hours of receipt and files reviews, appeals when appropriate.
• Performs collection activity on all assigned claims at a minimum of every 30 days.
• Follows collection and follow up procedures as established in the Policies and Procedures.
• Performs Technical Billing reviews on all claims prior to submission per Policies and Procedures.
• Performs Full Claim audits as defined in the Policies and Procedures.
• Will comply with all Corporate Initiatives and utilize provided tools/resources as appropriate.
• Other duties as assigned.

Requirements

KNOWLEDGE AND SKILL REQUIREMENTS

• High School Diploma or Equivalent
• Ability to learn medical terminology and healthcare software applications.
• Ability to do basic mathematics
• Ability to work independently and stay on task
• Ability to get to the job site
• Ability to work under stressful conditions
• Experience and Knowledge with Excel and Word
• Excellent Communication Skills
• In all activities comply with accreditation, legal, regulatory, and safety requirements.

PHYSICAL DEMANDS

• Must be able to routinely use standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines. Must be able to constantly operate a computer and other office equipment such as calculators, copy machines and printers up to 100% of the time;
• Regularly required to talk and hear in order to communicate effectively over the phone and in person;
• Must be able to see 100% of the time, with or without correction, to read information on a computer or calculator screen;
• This position is largely sedentary. Standing, walking, bending, kneeling, and stooping may rarely be required;
• Must be able to tolerate normal office environment.

PharmcareUSA is a national, closed- door, long term care pharmacy business with locations in multiple states. We are privately owned and continue to grow each year, providing daily deliveries to nursing and assisted living facilities as well as hospice residents. We are passionate about what we do and are looking for staff with the same attribute. Here at PharmcareUSA we strive to take care of our own staff as well as the customers we serve.