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Reimbursement Specialist Medical Collector

4 months ago

Laguna Hills, United States AmeriPharma Full time
Job DescriptionJob DescriptionSalary: $27-$31 Hourly/DOE

Mission Statement 

Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients. It is our joint and individual responsibility daily to demonstrate to outpatients, prescribers, colleagues, and others that We Care


AmeriPharma is a rapidly growing company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. We like people who are passionate about their roles and people who like to grow and change as the company evolves.


At AmeriPharma, you'll have access to:

  • Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
  • Great pay and general compensation structures
  • Employee assistance program to assist with mental health, legal questions, financial counseling etc.
  • Comprehensive PTO and sick leave options
  • 401k program
  • Plenty of opportunities for growth and advancement
  • Company sponsored outings and team-building events
  • Casual Fridays 


Job Summary

As a Reimbursement Specialist/Medical Collector at AmeriPharma, you will be responsible for accurate and timely claims reimbursement activities, including interactions with third party payers and patients as well as maintaining accurate records.


Duties and Responsibilities 

  • Reviews patient inventory of assigned accounts
  • Reviews accuracy of claims submitted and communicates to team members and management on any process inefficiencies and billing errors resulting in claim denials and underpayments
  • Verifies newly submitted claims status to ensure that claims are on file with insurance, in process, and hold payers accountable for accurate and timely reimbursement
  • Reviews accuracy of claim payments received from payers and patients
  • Identify and communicate to the management team in a timely manner on inadequate reimbursement rates that may require a pharmacy transfer
  • Submits appeals and pursues additional payments on any medical claims denied in error or paid less than the expected reasonable maximum allowable rate for the procedure codes submitted and level of patient’s benefit coverage
  • Submits letter of negotiations and obtain payment resolutions from claim payers
  • Performs collections on patient balances ensuring maximum reimbursement for all services provided
  • Ensures submission of complete and appropriate clinical documentation when justifying claims medical necessity
  • Independently perform claims follow-up and collections activities such as resolving claims denials and rejections through claim resubmissions, corrected claims and appeals in compliance with Billing Department’s approved reimbursement strategies in a timely manner
  • Effectively review and interpret benefits details and Identify and communicate on any inaccuracies in benefit details affecting claims reimbursement
  • Document detailed claim status on each patient’s account (new or otherwise) accurately and in a timely manner
  • Creates and utilizes reminders and follow up reports to ensure completion of any incomplete or pending activities
  • Escalates to management on any unresolved claim issues after proper claim resolution attempts that have been made
  • Maintains a positive DSO on assigned account inventory
  • Provides the highest level of customer service in answering patient phone calls and resolve patients’ questions and/or billing issues, as well as communicate with doctors’ offices and their staff
  • Identifies and communicates to the management team on any incomplete or inaccurate billing related databases resulting in billing errors and process delays in a timely manner
  • Ensures compliance with all payer rules and regulations
  • Ensures compliance with all company policies and procedures
  • Other duties as assigned


Required Skills 

  • Ability to read, write, speak, and understand the English language
  • Collaborate and cooperate with other team members and management for all Pharmacy needs
  • Excellent time management, communication, interpersonal, multi-tasking, and prioritization skills
  • Strong interpersonal skills
  • Ability to support colleagues in a fast-changing environment, collaborative, service oriented, social perceptiveness
  • Ability to work independently with minimal guidance
  • Ability to type with minimal errors
  • Ability to read, comprehend, analyze, and interpret data
  • Ability to apply common sense understanding and principles of logical thinking to a wide range of intellectual and practical problems and to deal with abstract and concrete variables
  • Ability to work the hours that will ensure all projects and duties are completed in a timely manner


Education Requirements 

  • High School Diploma
  • Experience as a medical coder/biller with a working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement 
  • Knowledge of ICD 10, CPT, HCPC, J billing codes and medical terminology
  • Knowledge of Government Appeals, and submission guidelines
  • Knowledge of reimbursement appeal strategies and claims escalations
  • Knowledge of automated billing systems and CMS HCFA 1500 form
  • Advanced knowledge of Word, Excel, and Outlook functions


Preferred Skills and Education

  • Microsoft Office/Excel
  • 1 year of Pharmacy experience 
  • Experience with CPR+ 


Schedule Details 

  • In-Person (Laguna Hills, Ca.) 
  • Monday-Friday 8:30am-5:00pm 
  • Training period for 1-2 weeks done in Orange, Ca. after training will transition to Laguna Hills, Ca. 


Physical Requirements 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is continuously required to sit and talk or hear. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and stoop, kneel, crouch or crawl. The employee must regularly lift and/or move up to 20 pounds and occasionally lift/or move up to 30 pounds. Specific vision abilities required by this job include close vision, peripheral vision, depth perception and the ability to adjust focus.


EEO Statements 

The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The duties and responsibilities of this position are subject to change and other duties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, age, protected veteran status, or based on disability or any other legally protected class.