Reimbursement/Billing Specialist

Afinida•Metairie, LA

7d•$28

About The Position

Position Overview: The Reimbursement/Billing Specialist is responsible for a portfolio of accounts receivable and oversees the billing cycle from charge review, claims submission and follow-up. The employee is engaged in a proactive and independent collection of outstanding balances for specially handled IV Services, LLC., pharmacy accounts. The Reimbursement/Billing Specialist will serve as the technical expert for complex workflows. The specialist is responsible for handling charge review edits, claim edits and preparation, insurance follow-up, denial resolution, and necessary follow-up to ensure accurate payment.

Requirements

In-depth understanding of Pharmacy billing policies and procedures including NCPDP D.0 standards
Proficiency in spreadsheet and database software
Advanced analytic ability
Ability to make good judgments in demanding situations
Effective communication skills
Ability to logically and accurately organize details
Ability to manage multiple tasks with ease and efficiency
Ability to work independently and be result oriented
Positive, can-do attitude coupled with a sense of urgency
Effective interpersonal skills, including the ability to promote teamwork
Ability to ensure a high level of customer satisfaction including employees, patients, visitors, faculty, physicians and external stakeholders
Ability to use various computer applications including EPIC, Microsoft Office, etc
Basic math skills and knowledge of general accounting principles
Knowledge of medical and insurance terminology, CPT, ICD coding structures, and billing forms (UB, UCF, 1500)
Maintain confidentiality of sensitive information
Knowledge of local, state and federal healthcare regulations
An Associate degree in Business, Finance, Health Information Management, or related field preferred
3-5 years of experience in a healthcare revenue cycle or clinic operations role
3-5 years of experience in an infusion pharmacy setting

Responsibilities

Maintain a portfolio of accounts receivable for the pharmacy
Follow accounts through the Pharmacy revenue cycle, including but not limited to: verifying patient coverage information, updating registration, completing charge review, claim edits and claim submissions, and following up with third party payers and patients to facilitate prompt resolution of outstanding account balances
Communicate with Revenue Cycle teams, payors and others to resolve account problems; participate in meetings as needed to address payor concerns
Evaluate the payment status of outstanding third-party claims and resolve impediments to payment by providing information such as medical records, itemization of charges, information regarding other insurance benefits, and explanation of charges
Actively participates in both external third-party audits and in internal audits and quality improvement initiatives, maintains documentation of current workflows, assists with special projects, and works closely with third party billing teams, Dalrada Corporate Accounting teams, and with Pharmacy Department Leadership and Prior Authorization teams
Perform complex patient account follow-up activities and actively participates in quality improvement initiatives to improve accounts receivable processes
Accurate and timely processing of appeals to various pertinent payers or programs
Review and validate adjustments to accounts in the insurance portfolio based on insurance reimbursement, coverage, contracts and services provided
Review charges to ensure filing to correct guarantor (e.g. work comp vs. personal/family)
Conduct collection calls to patients with outstanding balances and negotiate full payment from patients and/or assist patients in setting up a payment plan
Provide education to patients on UW Health’s financial assistance policy and application process and direct patients to the appropriate resources as necessary (e.g. Financial Counseling, Patient Relations)
Receive, document, and respond to all patient correspondence in a prompt and courteous manner; accurately document all actions taken to reconcile outstanding balances
Assist patients in coordinating appeal processes with their insurance company
Review self-pay undistributed and credit balance accounts and provide refunds to patients as necessary
Accurately post EFT, cash and checks made payable to IV Services, LLC., to the billing system
Ensure that all transactions are completed within the appropriate guidelines, policies and regulations, typically the same day received
Process electronic remittance files, payor work queues, and generate payment reports to balance
Communicate with IV Services, LLC., staff, insurance companies, financial institution and third-party payors to resolve issues related to proper posting of payments
Complete work on special projects, queries and reports as assigned
Other duties may be assigned as needed by management.