Medical Billing and Collections - Home Infusion Claims 24-00002 - Alura Workforce Solutions

Position
Medical Billing and Collections 
(Pharmacy/Infusion Claims)

Description
The Medical Billing and Collections Representative responsible for accurate and timely claims billing and reimbursement activities, including interactions with third-party payers and patients as well as maintaining accurate records.

Essential Functions

• Performs timely and quality IVIG Billing and  AR follow-up on Home Infusion and Specialty Pharmacy Claims
• Reviews patient inventory of assigned accounts.
• Reviews the accuracy of claims submitted and communicates to team members and management any process inefficiencies and billing errors resulting in claim denials and underpayments.
• Verifies newly submitted claims status to ensure that claims are on file with insurance, in process, and hold payers accountable for accurate and timely reimbursement.
• Reviews accuracy of claim payments received from payers and patients.
• Identifies and communicates to the management team in a timely manner accounts with inadequate reimbursement rates that may require a pharmacy transfer.
• Submits appeals and pursues 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.
• Submits letter of negotiations and obtain payment resolutions from claim payers.
• Performs collections on patient balances ensuring maximum reimbursement for all services provided.
• Ensures submission of complete and appropriate clinical documentation when justifying claims medical necessity.
• Independently perform claims follow-up and collections activities such as resolving claims denials and rejections through claim resubmissions, corrected claims, and appeals in compliance with Billing Department's approved reimbursement strategies in a timely manner.
• Effectively reviews and interprets benefits details. Identifies and communicates any inaccuracy in benefit details affecting claims reimbursement.
• Documents detailed 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
• Escalates to management any unresolved claim issues after proper claim resolution attempts have been made.
• Maintains a positive DSO on assigned account inventory.
• Provides the highest level of customer service in answering patient phone calls and swiftly resolve patients' questions and/or billing issues, communicating with doctors 'offices and their staff.
• Identifies and communicates to the management team any incomplete or inaccurate billing-related databases resulting in billing errors and process delays in a timely manner.
• Ensures compliance with all payer rules and regulations.
• Ensures compliance with all company policies and procedures.
• Other duties as assigned.

• Minimum 5 years experience as a medical coder/biller/collector with a working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement is required.
• Knowledge of ICD 10, CPT, HCPC and J billing codes and medical terminology, with CMS HCFA 1500 form & Electronic Billing required
• IVIG Billing and Collections experience is required 
• Ability to read, write, speak, and understand the English language
• Collaborate and cooperate with other team members and management for all pharmacy needs
• Excellent time management, communication, interpersonal, multi-tasking and prioritization skills
• Strong interpersonal skills
• Ability to support colleagues in a fast-changing environment, collaborative, service-oriented, social perceptiveness
• Ability to work independently with minimal guidance
• Ability to type with minimal errors
• Ability to read, comprehend, analyze, and interpret data
• Ability to apply common sense understanding and principles of logical thinking to a wide range of intellectual and practical problems and to deal with abstract and concrete variables
• Ability to work the hours that will ensure all projects and duties are completed in a timely manner.

Education Requirements

• High School Diploma required
• Billing and/or Coding Certificates is highly preferred