Reimbursement Specialist

California Specialty Pharmacy,LLC•Visalia, CA

About The Position

The Reimbursement Specialist role is responsible for monitoring and resolving patient accounts to ensure patient financial responsibility or out-of-pocket monies are collected. This role will develop and create relationships with the patient or guarantor, to assist with all financial inquiries, explanation of benefits and non-covered services.

Requirements

2 or more years of experience in healthcare, reimbursement with focus on insurance verification, billing and collection functions
Strong computer skills (Microsoft Word, Excel, PowerPoint)
Exceptional communication - verbal and written
Exceptional interpersonal skills
Exceptional organizational and process skills
Ability to work well under pressure, meet timelines, and completes assigned projects.
Exceptional critical thinking and problem solving skills
Proven performance, history in related field
Exceptional attention to detail and demonstrated results
Exceptional track record of customer satisfaction

Nice To Haves

Experience with coordination of benefits, including but not limited to patient pay, HMO, PPO, TPA, state and federal payors.
Prior work in specialty or home infusion, homecare or related field.

Responsibilities

Informs patient of home health/home infusion coverage and as appropriate, financial responsibility
Creates Insurance Benefit Summary (IBS) documents as needed
Collects out-of-pocket co-pays, deductibles, and co-insurance prior to services rendered in accordance with the insurance eligibility/coverage information provided by payor at time of insurance verification
Collects payment from self-pay patients for non-covered services
Processes patient-pay payments
Documents all patient interaction in EMR as a billing note
Resolves complicated inquiries or issues relating to patient accounts, to include screening for financial hardship and patient responsibility
Manages, monitors, and reviews patient pay AR accounts according to established guidelines
Ensures patient pay accounts are current
Serves as a resource and problem resolution expert for patients, Intake and Sales
Receives patient pay complaints and provides appropriate solutions, follow-up to ensure resolution
As needed, verifies insurance coverage and eligibility through payor websites, E1 check, or by calling the payor directly. Documents information into EMR and communicates as appropriate to team members.
Assists with Ready To Bill (RTB) as appropriate
Performs other duties, special projects as assigned