CarepathRx-posted 2 months ago
Full-time • Entry Level
1,001-5,000 employees

The Billing Specialist is responsible for managing third-party billing and collections, ensuring timely and accurate billing of claims. This role involves billing medical and NCPDP claims, identifying and resolving root cause of rejections, with the goal of resolving discrepancies and maximizing reimbursement. The ideal candidate will have knowledge of home infusion, medical billing practices, and payer reimbursement guidelines, as well as strong communication and problem-solving skills. The position requires attention to detail, the ability to work independently, and proficiency with Microsoft 365.

  • Understand Third Party Billing.
  • Ensure the timeliness and accuracy of billing.
  • Meet quality assurance, benchmark standards, and maintain productivity levels as defined by management.
  • Identifies patient and insurance changes.
  • Processes Home Infusion/Nursing claims.
  • Processes rejections for NCPDP claims to determine if the claim needs to be refiled or submitted for an appeal with the payer.
  • Able to identify billing trends.
  • Performs other duties as assigned.
  • Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary.
  • High school diploma or GED equivalent.
  • One to three years of related prior work experience in a team-oriented environment.
  • Experience in medical field and administrative record management.
  • Strong customer service background.
  • Knowledge of Home Infusion.
  • Knowledge of insurance policies and requirements.
  • Knowledge of medical billing practices and of billing reimbursement.
  • Collections or medical billing experience with basic understanding of ICD910, CPT4, HCPCS, and medical terminology is preferred.
  • Basic knowledge of Microsoft Office.
  • Knowledge of HCN 360 and/or CPR+ preferable.
  • Medicare knowledge of billing requirements specific to DMEMAC.
  • Medical, dental and vision coverage effective 1st of the month following date of hire.
  • Flexible spending.
  • Company-paid life insurance and short-term disability.
  • Voluntary benefits.
  • 401(k) with Company Match.
  • Paid Time Off and Volunteer Time Off.
  • Paid Company Holidays.
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