Remote, FL, USA
24 days ago
Collections Specialist

CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services.

Job Details:

 
We are seeking a dedicated  PBM Collections Specialist for our Revenue Cycle Team. In this position you will be responsible for the collections of insurance claims. 
 
Responsibilities 

Understand Third Party Billing and Collection Guidelines. 

Identify root cause of issues and demonstrate the ability to recommend corrective action steps to eliminate future occurrences of denials. 

Meet quality assurance, benchmark standards and maintain productivity levels as defined by management. 

Contacts payer, or patient as appropriate 

Documents all collections activity in patient collections notes 

Documents work performed/action taken on AR Aging Report and/or Over/Under Report 

Process all Payer appeal requests within the time frame required by the Payer 

Processes all approved adjustments 

Processes rejections and denials to determine if the claim needs to be refiled or submitted for an appeal with the payer 

Reviews patient information in appropriate system to determine why the claim is unpaid, if an adjustment is valid and whether additional approval is required 

Able to identify errors, correct claims and reprocess for reimbursement Able to read and interpret an EOB for accurate understanding of denial 

Knows how to investigate claims, contracts for reimbursement 

Performs other duties as assigned 

 
Qualifications
Employment is contingent on 

Background investigation (company-wide) 

Drug screen (when applicable for the position) 

Valid driver's license in state of residence with a clean driving record (when applicable for the position) 

Qualifications

High school graduate or equivalent. Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary. 

High school diploma or GED equivalent 

One to three years of related prior work experience in a team-oriented environment 

Experience in medical field and administrative record management 

Strong customer service background 

Skills & Abilities

Ability to communicate with patients, payors, outside agencies, and public through telephone, electronic and written correspondence. 

Effectively communicate in English; both oral and written, with physicians, location employees and patients to ensure questions and concerns are processed in a timely manner 

Helpful, knowledgeable, and polite while maintaining a positive attitude 

Interpret a variety of instructions in a variety of communication mediums 

Knowledge of Home Infusion  

Knowledge of insurance policies and requirements 

Knowledge of medical billing practices and of billing reimbursement 

Maintain confidentiality and practice discretion and caution when handling sensitive information 

Multi-task along with attention to detail 

Must be able to accurately perform simple mathematical calculations using addition, subtraction, multiplication, and division 

Self-motivation, organized, time-management and deductive problem-solving skills 

Work independently and as part of a team 

Collections or medical billing experience with basic understanding of ICD9, CPT4, HCPCS, and medical terminology is preferred. 

Familiarity with third party payor guidelines and reimbursement practices and available financial resources for payment of balances due is beneficial. 

Medicare knowledge of billing requirements specific to DMEMAC 

HCN360, CPR+, Caretend knowledge preferred. 

CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.

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