Reimbursement Specialist /Collectors (Multiple Roles, Beverly Hills & Laguna Hills, CA)

AmeriPharma • Laguna Hills, CA

3d • Onsite

About The Position

AmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. We like people who are passionate about their roles and people who like to grow and change as the company evolves.

We are seeking Reimbursement Specialists, from entry-level to experienced, to join our dynamic team. The ideal candidate will be responsible for ensuring accurate and timely collections to maximize reimbursement experience. This role is essential in ensuring accurate and timely collections and maximizing reimbursement through effective interactions with third-party payers, insurance plans, and patients. The candidate will possess strong analytical skills, be detail-oriented, and excel in submitting claims, appeals, and resolving discrepancies with minimal supervision.

Requirements

• Ability to read, write, speak, and understand the English language fluently.
• Ability to collaborate with other team members and management for all pharmacy needs.
• Strong time management, communication, multitasking and organizational skills.
• High attention to detail and strong analytical and problem-solving skills.
• Ability to work collaboratively in a fast-paced team environment.
• Ability to work independently and meet deadlines with minimal supervision.
• Strong attention to detail with the ability to type accurately and analyze data.
• Ability to apply logical thinking to solve complex and practical problems.
• Flexible and able to work hours that ensure timely completion of projects and duties.
• High School Diploma or equivalent.
• Minimum of 1 year of hands-on experience in medical coding/billing with a working knowledge of managed care, commercial insurance, Medicare and Medicaid reimbursement required.
• Experience with Benefit Investigation and Patient Responsibility Agreements.
• Advanced proficiency in Microsoft Word, Excel, and Outlook.

Nice To Haves

• Experienced specialists will have in depth Knowledge of managed care, commercial insurance, ICD-10, CPT, HCPC codes, J billing codes, and medical terminology, along with CMS HCFA 1500 forms & Electronic Billing, and n-depth understanding of healthcare billing and coding processes.
• Experience with automated billing systems, CPR+ is preferred.

Responsibilities

• Provide essential support in managing patient accounts and ensuring the timely recovery of payments.
• Administrative support for Accounts Receivable (AR) management, including reviewing the patient inventory of assigned accounts and collecting on open AR inventory to meet our goal of receiving reimbursements within 60 days of the billed date.
• Correlate insurance coverage with services to be provided.
• Prepare and review insurance claims.
• Ensure that all Copay Assistant claims are billed promptly to the appropriate Foundation.
• General collections on patient balances.
• Manage all assigned correspondence before due dates.
• Actively assist in maintaining a positive Days Sales Outstanding (DSO) on the assigned account inventory.
• Manage all aspects of the Accounts Receivable (AR) life cycle for assigned patient accounts.
• Aggressively collect on all open AR inventory and patient balances, ensuring that reimbursements are received within 60 days of the billed date and consistently maintaining a positive Days Sales Outstanding (DSO) on the assigned account inventory.
• Prepare and review complex insurance claims.
• Actively collecting on open AR to ensure payment within 60 days of billing.
• Managing and responding to correspondences by their due dates.
• Reviewing contracts and fee schedules for accurate reimbursement.
• Verifying insurance coverage alignment with services provided.
• Auditing open inventory.
• Verifying and following up on insurance claims and accounts receivable.
• Ensuring timely billing for Copay Assistant claims.
• Collaborating with other departments for necessary documentation.
• Answering incoming calls.
• Submitting appeals and pursuing additional payments on any medical claims denied in error or paid less than the expected reasonable maximum allowable rate for the procedure codes submitted and level of patient’s benefit coverage.
• Navigating complex insurance policies.
• Ensuring the accuracy of received reimbursement payments.
• Reviewing the accuracy of submitted claims.
• Communicating process inefficiencies or billing errors that lead to claim denials or underpayments to team members and management.
• Perform other duties assigned by management.

Benefits

• Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
• Great pay and general compensation structures
• Employee assistance program to assist with mental health, legal questions, financial counseling etc.
• Comprehensive PTO and sick leave options
• 401k program
• Plenty of opportunities for growth and advancement
• Company sponsored outings and team-building events
• Casual Fridays

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 11-50 employees