Billing Specialist

Soleo Health Inc•Atlanta, GA

31d•Remote

About The Position

Soleo Health is seeking a Billing Specialist to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care! The Billing Specialist will primarily be responsible for insurance and self-pay billing, excluding Medicare. This role is also responsible for submitting electronic and paper claims. Follows up with clearing house vendors on accepted and working rejections.

Requirements

2 years or more of home infusion billing required
High School Diploma or equivalent
Knowledge of HCPC coding and medical terminology
Experience providing customer service to internal and external customers
Must be computer literate
Must be dependable. Excellent phone and email communication skills.
Working knowledge of ICD10, CPT, NCCI; must be familiar with modifier application and standard billing regulations

Responsibilities

Preparation of accurate medical claims based on contracted agreements for services to various payers (e.g. Commercial Payers, Government Payers, Employer/ Institutional Payers).
Reviewing and identifying claims pricing discrepancies based on updates/changes to fee schedules.
Creates and submits secondary electronic pharmacy and medical claims in a timely manner.
Billing of manufacturer copays, which includes entering the necessary information into portal or billing via paper at time of initial billing.
Monitors billing requirements pursuant to contracts with third party payers or government programs.
Answer insurance/billing questions from branch staff and help educate.
Review information from electronic medical records in patient account (IE: auth, benefit verification, orders, accounts receivable, etc.) to ensure preparation and submission of clean claims.
Perform routine revenue review of claims billed within the current month.
Answering incoming calls and triage if necessary.
Create claim batches and process them via electronic submission.
Manually process any claims that are not eligible for electronic billing. Identify any claims that need attention, make corrections, and resubmit.
Ensure coding to the highest level of specificity and for maximum reimbursement by third party payers.
Daily review and follow up of unbilled delivery tickets in billing review and ready to bill queues.
Accurately notate patient accounts to reflect all actions made including marginal, split claim notes, missing COGS, etc.
Coordinates with the pharmacy team daily to ensure any PBM issues are addressed and resolved, accepted into revenue and billed timely
Effectively utilize time and resources to meet performance goals.
Provides exceptional Customer service to internal and external customers.
Ensures compliance with federal, state, and local governments, third party contracts, and company policies.
Clearly communicate any billing related issues to all appropriate parties including: Intake, collections, RBL, and manager.
Monitoring the unbilled-pending invoices queues and communicate to the branch on missing or needed documents or information.
Maintain current knowledge of departmental and organizational policies.