Reimbursement Specialist

3 weeks ago

Torrance, United States Premier Infusion and Healthcare Services, Inc. Full time

Come Join the Premier Infusion & Healthcare Family At Premier we offer employees stability and opportunities for advancement. Our commitment to our core values of Compassion, Integrity, Respect and Excellence in People applies to our employees, our customers, and the communities we serve. This is a rewarding place to work


Premier Infusion and Healthcare Services is a preferred post-acute care partner for hospitals, physicians and families in Southern CA. Our rapidly growing home health and infusion services deliver high-quality, cost-effective care that empowers patients to manage their health at home. Customers choose Premier Infusion and Healthcare Services because we are united by a single, shared purpose: We are committed to bettering the quality of life for our patients. This is not only our stated mission but is what truly drives us each and every day. We believe that our greatest competitive advantage, our greatest asset are our employees, our Premier Family in and out of the office sets Premier apart.


PREMIER BENEFITS - For FULL TIME Employees:

● Competitive Pay

● 401K Matching Plan - Up to 4%

● Quarterly Bonus Opportunities

● Medical, Dental & Vision Insurance

● Employer Paid Life Insurance

● Short Term / Long Term Disability Insurance

● Paid Vacation Time Off

● Paid Holidays

● Referral Incentives

● Employee Assistance Programs

● Employee Discounts

● Fun Company Events


Description of Responsibilities

Coordinates and performs business office activities involved with collecting payments for Premier Infusion Care products and follows established procedures for billing.


Reporting Relationship

Billing Manager


Responsibilities include the following:

1. Performs all aspects of billing for commercial insurance companies/ health plans, medical groups, hospitals, hospice facilities, NCPDP, and/or MSO’s

2. Bills Medicare for PR-96/204 (denials) required for secondary billing submissions.

3. Follows up on EOB’s (explanation of benefits) which includes:

- Medicare denials

- Billing secondary insurance after Medicare’s has denied claims.

4. Calling insurance companies for explanation of denials if questionable.

5. Making corrections on deny claims and re-bills insurance companies.

6. Checks EOB’s with contracted fee schedule for accuracy or adjustments as needed.

7. Request medical records from the doctor or hospital if needed to bill insurance.

8. Verifies payors are accurate in the system.

9. Verifies pricing is accurate on claims.

10. Patient calls for benefit, invoicing, and explanations as needed.

11. Insurance, benefits verifications, and authorizations as needed.

12. Filing paperwork as needed.

13. Helps pull attachments as needed.

14. Interfaces with staff in other departments to gather information needed for accurate and completing billing.

15. Resolves electronic (Office Ally, Novologix, or Emdeon clearing house) report matters.


Minimum Qualifications:

  • Effective interpersonal, time management and organizational skills.
  • Office experience preferred.
  • Computer skills that include word processing, and efficient use of the internet and e-mail.
  • Must possess excellent oral and written communication skills, with the ability to express technical issues in “layman” terms.
  • Must be detail oriented.


Education and/or Experience:

  • Must have a High School diploma or Graduation Equivalent Diploma (G.E.D.) or Higher.
  • At least 1 –2 years of medical or pharmaceutical billing experience or related A/R
  • Knowledge of insurance verification procedures.
  • Proficiency in 10-key preferred.
  • Prior experience in a pharmacy or home health company is of benefit.
  • Prior experience in a consumer related business is also of benefit.


Equal Employment Opportunity (EEO)

It is the policy of Premier Infusion & HealthCare Services to provide equal employment opportunity (EEO) to all persons regardless of age, color, national origin, citizenship status, physical or mental disability, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status, or any other characteristic protected by federal, state or local law. In addition, Premier Infusion & HealthCare Services will provide reasonable accommodations for qualified individuals with disabilities.


Job Type: Full-time

Pay: $21.00 - $26.00 per hour


Benefits:


  • 401(k)
  • 401(k) matching
  • Dental insurance
  • Health insurance
  • Life insurance
  • Paid time off
  • Vision insurance


Schedule:


  • 8 hour shift
  • Monday to Friday


Experience:


  • ICD-10: 1 year (Preferred)
  • Medical Billing/Collections: 2 years (Required)
  • Home Infusion Medical Billing: 1 year (Preferred)
  • Clearing houses (Waystar/Change Health): 2 years (Preferred)
  • CPR+ billing system: 2 years (Preferred)

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