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 Patient Collections Specialist for our Revenue Cycle Team. In this position you will be responsible for resolving escalation requests for the collections of insurance claims.

Responsibilities

Ensure the timeliness and accuracy of escalation requests and resolution

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.

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

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

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

Processes all approved adjustments

Able to identify errors, correct claims and reprocess for reimbursement

Contacts payer, or patient as appropriate

Documents all collections activity in patient collections notes

Able to read and interpret an EOB for accurate understanding of denial

Understand Patient level benefits

Some knowledge of copay assistance programs and foundation programs

Knows how to investigate claims, and reimbursement contracts

Performs other duties as assigned

Qualifications

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) Education and/or Experience 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, Knowledge, and 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 and CPR+ 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.