Authorization Specialist - Buy and Bill Pharmacy

Crossroads Treatment Centers•Greenville, SC

4d•Onsite

About The Position

Crossroads Treatment Centers is seeking an Authorization Specialist - Buy and Bill Pharmacy. This role involves performing all duties and responsibilities in accordance with local, state, and federal regulations and company policies. The specialist will utilize and apply industry knowledge to resolve new and aged accounts receivables by working various account types, including professional claims, governmental and/or non-governmental claims, denied claims, aged accounts, high priority accounts, high dollar accounts, reimbursements, credits, etc. They will leverage available resources and systems to analyze patient accounting information and take appropriate action for payment resolutions, documenting all activity. Communication with payer resources (websites, portals, email, phone) is essential. The role requires maintaining quality and productivity standards, verifying patient benefits and eligibility for buy and bill drugs, obtaining authorizations, submitting claims, tracking claim status, and following up on denials. The specialist will also apply for co-pay assistance programs, interpret payer clinical guidelines and contract variances, understand third-party billing requirements, interpret claim scrubber edits/rejections, and prepare appeal letters for technical denials. Other duties as assigned.

Requirements

Must have had at least 2-3 years accounts receivable experience in a physician office setting.
General Knowledge of HCPCS, CPT-4 and ICD-10 coding and/or medical terminology.
Familiar with multiple payer requirements and regulations for claims processing.
Must have a High School Diploma/GED

Nice To Haves

Has previous Buy and Bill experience preferred

Responsibilities

Performs all duties and responsibilities in accordance with local, state, and federal regulations and company policies.
Utilize and apply industry knowledge to resolve new and aged accounts receivables by working various account types, including but not limited to professional claims, governmental and/or non-governmental claims, denied claims, aged accounts, high priority accounts, high dollar accounts, reimbursements, credits, etc.
Leverage available resources and systems (both internal and external) to analyze patient accounting information and take appropriate action for payment resolutions, document all activity in accordance with organizational and client policies.
Communicate professionally (in all forms) with payer resources to include websites/payer portals, e- mail, telephone, customer service departments, etc.
Maintain quality and productivity results at a level that meets departmental standards as measured by a daily/weekly/monthly average.
Verify patient benefits and eligibility for buy and bill drugs
Obtains authorization for buy and bill drugs as required by the various payors
Submit claims to insurance companies for buy and bill drug administration and related services.
Track claim status and follow up on denials or incomplete/pending claims
Apply on behalf of patient for co-pay assistance program as applicable
Ability to interpret payer clinical guidelines and identify contract variances affecting reimbursement.
Demonstrate clear proficiency in third-party billing requirements to include federal, state, and commercial/managed care payers.
Interpret claim scrubber edits/rejections and takes appropriate action necessary to resolve issues.
Seek resolution to problematic accounts and payment discrepancies.
Prepare appeal letters for technical denials by accessing specific payer appeal forms, submitting appropriate medical documentation and tracking appeal resolution.
Other Duties as Assigned.

Benefits

Medical, Dental, and Vision Insurance
PTO
Variety of 401K options including a match program with no vesture period
Annual Continuing Education Allowance (in related field)
Life Insurance
Short/Long Term Disability
Paid maternity/paternity leave
Mental Health Day
Calm subscription for all employees
Mileage reimbursement (if applicable) Crossroads matches the current IRS mileage reimbursement rate.
Community events that promote belonging and education.