Medical Biller / Reimbursement - Home Infusion RX Pharmacy Claims 24-00176 - Alura Workforce Solutions
Laguna Hills, CA 92868
About the Job
Position
Medical Biller / Reimbursement
(Home Infusion Billing Experience Required)
Medical Biller / Reimbursement
(Home Infusion Billing Experience Required)
- Performs pre-billing audits by reviewing the accuracy of assigned payer(s) to the patient’s account, completeness of benefits investigation, prior authorization, procedure codes, diagnoses, billing units, dates of service, billing charges, nursing visit notes and supporting medical records.
- Reviews completeness of necessary and applicable documentation such as the Financial Obligation Notification and Medicare Advance Beneficiary Notification (ABN).
- Creates medical claims accurately and in a timely manner.
- Adds necessary and applicable per diem charges to claims.
- Ensures accuracy of claims Place of Service.
- Appends procedure codes with accurate modifiers when applicable.
- Submits claims electronically and on a CMS 1500 paper claim format.
- Reviews new and existing patient accounts benefits details to ensure completeness and accuracy of patient’s coverage.
- Ensures submission of complete and appropriate clinical documentation when justifying claims medical necessity.
- Documents claim status on each patient’s account (new or otherwise) accurately and in a timely manner.
- Creates and utilizes reminders and follow up reports to ensure completion of any incomplete or pending activities
- Identifies and communicates to the management team in a timely manner accounts with inadequate reimbursement rates that may require a pharmacy transfer.
- Identifies and communicates any process inefficiencies resulting in claim denials and underpayments to management.
- Identifies and communicates any incomplete or inaccurate billing related databases resulting in billing errors and process delays to the management team in a timely manner.
- Assists in streamlining communication with reimbursement staff, patients, insurance companies, prescriber’s office, and other healthcare- related parties as needed.
- Provides the highest level of customer service in answering patient phone calls and swiftly resolve patients’ questions and/or billing issues, communicate with doctors’ offices and their staff.
- Assists in account collections activities as needed.
- Ensures compliance with all payer rules and regulations.
- Ensures compliance with all company policies and procedures.
- Other duties as assigned.
- Minimum (5) years of current Specialty Pharmacy billing experience
- Proficiency in billing IVIG and other biologics required
- Experience as a medical coder/biller with a working knowledge of managed care, commercial insurance, Medicare and Medicaid reimbursement required.
- Knowledge of ICD 10, CPT, HCPC and J billing codes and medical terminology, with CMS HCFA 1500 form & Electronic Billing.
- Knowledge of Benefit Investigation and Patient Responsibility Agreements.
- Knowledge of automated billing systems, experience with CPR+ preferred.
- Advanced knowledge of Word, Excel and Outlook functions.
- High School Diploma
- Full-time, on-site position
- Direct Placement, Benefited Position
Source : Alura Workforce Solutions
