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:

The Collections Specialist is responsible for managing third-party billing and collections, ensuring timely and accurate payment of claims, and processing payer appeals. This role involves investigating denials, processing rejections, and identifying root causes of payment issues, with the goal of resolving discrepancies and maximizing reimbursement. The ideal candidate will have knowledge of home infusion, medical billing practices, and payer reimbursement guidelines, as well as strong communication and problem-solving skills. The position requires attention to detail, the ability to work independently, and proficiency with Microsoft 365. Experience with ICD-10, CPT-4, HCPCS, and Medicare billing is preferred.

Responsibilities

Understand Third Party Billing and Collection Guidelines.

Identify root cause of issues and demonstrate recommendations for corrective action steps to eliminate future occurrences of denials.

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

Contact payer, or patient as appropriate.

Documents all collections activity in patient collections notes.

Documents work performed/action taken on AR Reports.

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

Reviews claim processing to determine proper payment has been issued.

Request and process 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.

Ability to identify errors, correct claims and reprocess for reimbursement.

Ability to read and interpret an EOB for accurate understanding of claim processing.

Knowledge of claims investigation and reviewing payer contracts for reimbursement.

Performs other duties as assigned.

Skills & Abilities

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

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, reimbursement practices, as well as claim processing requirements.

Knowledge of medical billing practices and of medical billing reimbursement.

Maintain confidentiality and practice discretion and caution when handling sensitive information.

Multi-task along with attention to detail.

Ability 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 ICD10, 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 and CPR+ knowledge preferred.

Knowledge of Microsoft 365 products, including but not limited to Outlook, Teams and Excel.

Strong customer service skills.

Requirements

High school graduate or equivalent.

Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary.

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.