Patient Resolution Specialist - Option Care

Extraordinary Careers. Endless Possibilities.

With the nation’s largest home infusion provider, there is no limit to the growth of your career.

Option Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. With over 6,000 team members including 2,900 clinicians, we work compassionately to elevate standards of care for patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the infusion care experience for patients, customers and employees.

As a two-year recipient of the Gallup Exceptional Workplace Award, we recognize that part of being extraordinary is building a thriving workforce that is as diverse as the patients and communities we serve.
Join a company that is taking action to develop a culture that is more inclusive, respectful, engaging and rewarding for all team members. We are committed to hiring, developing, and retaining a diverse workforce.

Job Description Summary:

Responsible for timely and accurate review and resolution of patient disputes, insurance payer grievances, and third-party complaints pertaining to patient billing and insurance concerns and overall customer experience. Evaluates company processes and procedures to ensure compliance with expected intake processes and documentation, submission of invoices to all applicable payers, reimbursement of any and all payments received by insurance payers, assistance programs, and patients and the accuracy of their application. Work cross-functionally with Option Care Health leaders to identify root causes and implement process improvements for future-state resolution.

Job Description: ​

Job Responsibilities:

• Review and resolve high-level patient disputes within five days of receipt. De-escalate conversations with patients via phone and email communications. Address patient concerns; identify the applicable parties required for resolve with minimal oversight.
• Draft official written correspondence related to grievances with various parties (e.g. patients, insurance payers, the Better Business Bureau, State Attorneys General, and patient attorneys).
• Create agenda of all assigned accounts for review with executive leadership for weekly meeting. Provide clear, professional written communications identifying the error, root cause, proposed resolution and future-state solve.
• Uphold all billing practices and processes compliant under Option Care Health’s contracts, policies, and expectations.
• Evaluate invoices to insurance payers, assistance programs, and patients for products and services received. Must understand the terms and billing procedures to ensure all billing submitted, processed, and paid as compliant and correct. Verify services and products are correctly authorized and that all required documentation is on file.
• Evaluate payments received from insurance payers, assistance programs and patients for correctness and accurate application in the system. Verify payments received are correct according to Explanation of Benefits and fee schedule. Transfer payments to applicable party for payment correction.
• Develop communications for various audiences within the organization to promote process improvements.
• Respond to all credit card chargeback disputes by Visa, MasterCard, Discover, and American Express timely. Conduct review of claims and dispute all unfounded requests with required documentation.

Supervisory Responsibilities:

Does this position have supervisory responsibilities? No.
(i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.)

Basic Education and/or Experience Requirements:

• High School Diploma or equivalent
• 1-2 years of experience in revenue cycle management, medical billing, and/or patient registration/patient onboarding

Basic Qualifications:

• Intermediate level skill in Microsoft Excel (for example: using SUM function, setting borders, setting column
• width, inserting charts, using text wrap, sorting, setting headers and footers and/or print scaling).
• Intermediate level skill in Microsoft Word (for example: inserting headers, page breaks, page numbers and
• tables and/or adjusting table columns).
• Intermediate level skill in Microsoft Outlook (for example: send and receive encrypt emails, insert attachments, create meeting invitations)
• Intermediate level skill in verbal and written communication. (Ability to communicate with variety of stakeholder and company leaders)

Travel Requirements:

None – 0%

Preferred Qualifications & Interests:

• Previous Infusion Medical Billing/Collections or Intake/Admissions Experience
• Basic understanding of medical billing and reimbursement
• Basic understanding of commercial and governmental insurance and benefits
• Strong customer service and problem solving skill set

Due to state pay transparency laws, the full range for the position is below:

Salary to be determined by the applicant's education, experience, knowledge, skills, and abilities, as well as internal equity and alignment with market data.

Pay Range is $18.78-$31.29

Benefits:

-401k

-Dental Insurance

-Disability Insurance

-Health Insurance

-Life Insurance

-Paid Time off

-Vision Insurance

Option Care Health subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information.

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