Reimbursement Specialist - RXB
About The Position
Responsibilities include verifying eligibility, coverage risk determination, claims setup, PBM adjudication, prior authorizations, computing cost versus reimbursement, account overview, patient out-of-pocket collection. We are located where the 405 and 55 freeways meet. May be eligible for quarterly incentive bonus. In office Monday to Friday 8:30 am – 5:30 pm with rotating Saturdays 9 am - 5 pm (Typically every 5th Saturday. Saturday rotations can be done remotely based on eligibility). Position includes 6 weeks of paid training, and the training may follow a different schedule.
Requirements
- Minimum of 2 years of medical, hospital, and/or HH billing
- 2+ years Pharmacy Technician or Medical Biller
- Familiarity with medical terminology
- Knowledge of proper billing/CMS guidelines
- Strong knowledge of insurance eligibility (Medicare [A-D], government, and commercial)
- Good understanding of ICD10 coding
- Familiarity with pharmacy coding (NDC)
- Pharmacy claim adjudication
- Prior Authorization process (submission and appeals)
- Coverage gap knowledge
- Familiarity with MS Word, Excel, Outlook, EMR
Responsibilities
- verifying eligibility
- coverage risk determination
- claims setup
- PBM adjudication
- prior authorizations
- computing cost versus reimbursement
- account overview
- patient out-of-pocket collection
Benefits
- 401(k) matching
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
