Maintain a positive work atmosphere by acting and communicating in a manner so that you work productively, effectively, and efficiently with customers, clients, co-workers, volunteers, and management.Essential Functions: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 third-party insurance, drug card, and Medicare claims daily for assigned accounts and serve as backup for other accounts as needed.Review EOBs and code payments received daily.Handle any remaining balance by filing claims to co-pay assistance, and creating patient statements or write offs as needed.Research and solve any payment discrepancies.Process correspondence and follow-up related to assigned accounts and provide backup duties for other accounts as needed.Work with Payer Relations Account Manager to research denied and improperly processed claims by contacting payers to ensure proper processing of said claims.Maintain denial reports and coordinate appeals ensuring that all notes are properly documented.Coordinate with Finance Accounts Payable with research for the coded payments for the different payers.In collaboration with Payer Relations Account Manager, research and respond to recoupments from PayersEnsure all assigned accounts are resolved timely and effectively in compliance with the payer agreement.Identify and attempt to resolve any issue preventing or slowing reimbursement.Stay updated on all third-party billing requirements and changes.Gather documentation and generate refund letters to insurance companies and Medicare, and work with finance to reconcile clients??? accounts.Send Client Assistance Program (CAP) letters to clients if they have a balance on their account.Maintain current A/R notes and all required documentation.
1-4 years
Team player who brings initiative, positivity and creativity to the table
Medical billing and coding certification preferredAt least 3 years??? experience in billing and collecting healthcare claimsFamiliarity with on-line billing software and 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 on given assignments and work collaboratively with team members.Strong time management skills with demonstrated ability to meet deadlines and handle multiple prioritiesMust be accurate and thorough???monitoring own work to check for errors.Ability to maintain confidentiality
Associate
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