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Medical Biller

4 months ago

Laguna Hills, United States AmeriPharma Full time
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 Medical Biller at AmeriPharma, you will be responsible for accurate and timely billing activities, including interactions with third party payers and patients as well as maintaining accurate records.

Duties and Responsibilities
  • Performs pre-billing audits by reviewing the accuracy of assigned payer(s) to the patient's account, completeness of benefits investigation, prior authorization, procedure codes, diagnoses, billing units, dates of service, billing charges, nursing visit notes and supporting medical records
  • Reviews completeness of necessary and applicable documentation such as the Financial Obligation Notification and Medicare Advance Beneficiary Notification (ABN)
  • Creates medical claims accurately and in a timely manner
  • Adds necessary and applicable per diem charges to claims
  • Ensures accuracy of claims Place of Service
  • Appends procedure codes with accurate modifiers when applicable
  • Submits claims electronically and on a CMS 1500 paper claim format
  • Reviews new and existing patient accounts benefits details to ensure completeness and accuracy of patient's coverage
  • Ensures submission of complete and appropriate clinical documentation when justifying claims medical necessity
  • Documents 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
  • Identifies and communicates to the management team in a timely manner accounts with inadequate reimbursement rates that may require a pharmacy transfer
  • Identifies and communicates any process inefficiencies resulting in claim denials and underpayments to management
  • Identifies and communicates any incomplete or inaccurate billing related databases resulting in billing errors and process delays to the management team in a timely manner
  • Assists in streamlining communication with reimbursement staff, patients, insurance companies, prescriber's office, and other healthcare- related parties as needed
  • Provides the highest level of customer service in answering patient phone calls and swiftly resolve patients' questions and/or billing issues, communicate with doctors' offices and their staff
  • Assists in account collections activities as needed
  • Ensures compliance with all payer rules and regulations
  • Ensures compliance with all company policies and procedures
  • Other duties as assigned

Skills Requirements
  • 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 required.
  • Knowledge of ICD 10, CPT, HCPC and J billing codes and medical terminology, with CMS HCFA 1500 form & Electronic Billing.
  • Knowledge of Benefit Investigation and Patient Responsibility Agreements.
  • Knowledge of automated billing systems, experience with CPR+ preferred.
  • Advanced knowledge of Word, Excel and Outlook functions.

Preferred Skills and Education
  • Microsoft Office/Excel: 1 year
  • Pharmacy: 1 year

Schedule Details
  • In-Person (Laguna Hills, Ca)
  • Monday-Friday 8:30am-5:00pm

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.