Reimbursement Specialist Medical Collector

2 weeks 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 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 mínimal guidance
- Ability to type with mínimal errors
- Ability to read, comprehend, analyze, and interpret data
- 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 kn

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