Job Details

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 Medical 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

• 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.

• 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