Responsible for following and tracking the claim from creation of an order,through complete account reconciliation, taking the necessary steps to ensure payment.Coordinate all insurance eligibility verifications for pharmacy clients.Proactively obtain prior authorization for all prescribed products.Ensure all systems have current and accurate insurance information listed.File medical and/or pharmacy benefit claims daily for assigned accounts and serve as backup for other accounts as needed.Follow up on filed claims to ensure they are adjudicated timely and according to payer contract.Review EOBs and allocate payments received daily.Research and resolve any payment discrepancies and ensure all assigned accounts are resolved timely and effectively in compliance with the payeragreement.Work with Payer Relations Account Manager to research denied and improperly processed claims and attempt to resolve any issue preventing or slowingreimbursement.Handle any remaining balance by filing claims to secondary insurers, co-pay assistance programs and creating patient statements or write-offs as needed.Send Client Assistance Program (CAP) letters and enrollment forms to clients when appropriate.Stay updated on billing requirements and changes for assigned payers.Process correspondence and follow-up related to assigned accounts and provide backup duties for other accounts as needed.Coordinate claim escalations and appeals to optimize collection opportunities.In collaboration with Payer Relations Account Manager, research and respond to recoupments from Payers.Gather documentation and generate refund letters to insurance companies and Medicare when needed, and work with finance to reconcile clients??? accounts.Maintain all required documentation in specified timeframe in specifiedtimeframe.
1-4 years
Ability to learn new software programsProficient in Microsoft Office Suite applicationsBe able to demonstrate high proficiency in Microsoft ExcelAbility to work independently on assigned tasks as well as to accept direction ongiven assignments and work collaboratively with team members.Strong time management skills with demonstrated ability to meet deadlines andhandle multiple prioritiesMust be accurate and thorough-monitoring own work to check for errors.Team player who brings initiative, positivity and creativity to the tableAbility to maintain confidentiality
Medical patient account or revenue management certification preferredAt least 3 years??? experience billing and collecting on healthcare claimsExperience with eligibility verification and prior authorization processes
No Degree Required
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