Reimbursement Specialist

BioMatrix Specialty Infusion Pharmacy•Overland Park, KS

12d•$23 - $27•Onsite

About The Position

BioMatrix is a nationwide, independently-owned infusion pharmacy with decades of experience supporting patients on specialty medication. Our compassionate care team helps patients navigate the often-challenging healthcare environment. We treat our patients like family and get them started on therapy quickly. We work closely with them as well as their family and their healthcare providers throughout the patient journey, staying focused on optimal clinical outcomes. At BioMatrix the heart of our Inclusion, Diversity, Equity, & Access (IDEA) philosophy is the commitment to cultivate a welcoming space where everyone’s contributions are acknowledged and celebrated. Our goal is to draw in, develop, engage, and retain talented, high-performing individuals from diverse backgrounds and viewpoints. We believe that both respecting and embracing diversity enriches the experiences and successes of our patients, employees, and partners. The Reimbursement Specialist is responsible for the accurate and timely billing and reimbursement of claims.

Requirements

High School Diploma or GED required
Minimum of two (2) years of medical insurance experience required
Basic computer and internet skills (e.g. Microsoft Office)
Strong customer service skills, focus and dedication.
Commitment to excellent customer service and professionalism to resolve complex payer coverage issues

Nice To Haves

Minimum of two (2) years of home infusion experience preferred
Prior experience with CPR+ and/or CareTend preferred
Certified Pharmacy Technician/License preferred, but not required

Responsibilities

Submits accurate claims to primary and secondary insurers and resubmits accurate corrected and rejected claims in a timely manner.
Acquires necessary authorizations and current eligibility information from insurance company for the dispense prior to release of delivery; communicates findings with pharmacy prior to delivery; documents notes in system.
Maintains patient files with pertinent information required by insurance companies (CMN, rxs, medical records, etc.).
Prior to submitting claims, confirms that orders have been delivered verifying date of delivery.
Invoices patients for patient responsibility amounts (co-pay, deductible, out-of-pocket, etc.).
Communicates with field staff as needed (new referrals, signed tickets).
Responsible for billing audits both internally and externally.
Tracks each claim on a weekly basis; maintains A-R Manager report in Excel and updates each outstanding claim with a status detail note, includes insurance company’s reference number; submits report to the Director of Revenue Cycle Management; updates the claim’s billing note in CPR+ with the status detail note.
Predicts cash flow from claim’s progress through insurance system.
Maintains documents showing proof of communique with insurance companies, providers, etc. (i.e. email printouts, fax confirmations, FedEx tracking).
Tracks incoming checks for receipt; if issued to patient, communicates with patient or RCC to collect monies.
Responds to insurance requests in a timely manner (medical records, rxs, CMNs, etc.)
Makes bank deposit and maintains accurate monthly deposit report, as needed.
Verifies new patient referral information with insurance company, reports findings to Director of Revenue Cycle Management via insurance verification form
Completes insurance company contracts and/or necessary forms to maintain or become a provider.
Reports unusual events or trends related to claims or insurance industry to Director of Revenue Cycle Management.
Assists in insurance audits by providing all necessary billing paperwork in a timely manner.
Proactively improves understanding of bleeding disorders, products and treatments; stays current on legislative changes and insurance coverages, and is capable of disseminating this information to employees, patients and others within the bleeding disorder community.
Participation in QMC Quarterly Meetings, as needed.
Participates in orientation, education, training programs, CE’s, literature reviews and other materials, as assigned.
Completes all competence/skills billing assessments as required.
Provides courteous, cooperative and timely service to patients, visitors, and staff.
Participates in quality assurance activities and audits, as directed.
Ability to maintain competence for current position.
Ability to maintain accurate records and prepare reports and correspondence related to the work.
Ability to perform work within specified time frames and adapt positively to frequent interruptions and changes in workload and/or work schedule.
Strong customer service skills, focus and dedication.
Excellent interpersonal and organizational skills.
Ability to set priorities and solve problems.
Excellent verbal, written, and communication skills.
Ability to respond quickly to emergency requests.
Self-motivated, self-reliant and team oriented.
Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; Participates in meetings.
Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.
Become and remain proficient is all programs necessary for execution of the position.