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Account Representative- Pharmaceutical Department

4 months ago

Sacramento, United States Retina Sacramento MSO LLC Full time

Come and join our team We are a local growing private medical practice specializing in the diagnosis and treatment of patients with diseases of the retina and vitreous. We are looking for individuals who would like to establish a career in healthcare working for a company with nationally recognized physicians. We provide on the job training giving you the ability to grow and advance your skills along with gaining innovative knowledge. Established in 1977, we have locations all over Northern California including Sacramento, Grass Valley, Roseville, Stockton, Modesto, Merced, Fairfield, Elk Grove, Folsom, Yuba City and Chico. Our physicians are nationally known, and we continue to be on the leading edge of retina care by utilizing the latest equipment and both participating in and designing new clinical trials to advance the state of care for retinal diseases. Join 250+ other team members working for our nationally recognized retina specialty practice in a fast paced, high volume medical office. This position has the possibility of being remote, **must be local to the Sacramento area**.

As a result of high cost injectable drugs being used in the practice, the pharmaceutical (drug) department was created specifically to perform the pre-visit process for these drugs, and to follow-up on unpaid balances, to ensure that the practice would be paid for these injected drugs. For each scheduled drug injection patient, this department is responsible for obtaining and/or verifying insurance coverage and eligibility, investigating drug benefits, obtaining pre-authorization (if necessary), communicating to the patient their financial responsibilities (including past due balances) for services to be provided by the physician as well as helping the patient to access any financial or co-pay assistance programs available. The drug department is responsible for making reasonable efforts to collect the patient portion prior to the injection. The drug department also addresses any drug related insurance claim denials or outstanding accounts receivable balances. Additionally, the drug department is responsible for accounting for, and the proper storing of, the inventory of these high cost drugs at each clinic location.

**Responsibilities**
- Interacting with patients face-to-face or via telephone regarding billing questions
- Composing effective appeal letters for initial and second level appeals
- Assessing account balances and make determination on further actions
- Provide co-pay assistance help to the patients
- sending out packets, answering questions, enrolling online, and helping with information to qualify patients.
- Utilize payers’ websites to check claim and appeal status
- Answer the drug team queue calls from patients and clinics.
- Other duties as assigned
- H.S. Diploma or equivalent (GED)
- Experience with medical billing and reimbursement requirements and procedures for government programs, private third-party insurance, and private individuals
- Experience analyzing and interpreting various types of insurance explanation of benefits and remittance advices
- General knowledge of credit and collection practices and basic accounting practices
- General knowledge of CPT and ICD10 policies related to medical billing
- Excellent math skills
- Excellent organization and communication skills
- Proficient in Microsoft Word, Excel, Outlook, and PowerPoint
- Must be able to learn and adapt to new processes
- Attention to detail and ability to multitask
- Ability to meet daily department goals
- Must be local to the Sacramento area

Preferred Qualifications:

- Minimum 2+ years of related medical billing experience (willing to train the right person)
- Experience with NextGen
- Experience with Experian ClaimSource and Denial Manager
- Spanish speaking

Physical Requirements:

- Sitting and viewing computer screen for extended periods, up to 85% of the time
- Keyboarding, up to 90% of the time
- Standing, up to 25% of the time
- Lifting, reaching, and bending, up to 45% of the time
- Close visual acuity required to perform duties such as viewing computer monitor, and determining accuracy and thoroughness of work

**Full-time immediate employee benefits**:
Paid Time Off (PTO) 13 days per year, as accrued.
7 Paid Holidays per year.
Scrub Allowance
Ability to participate in company 401k plan offered through Fidelity.

**On the first of the month following 30 days of employment benefits**:
Medical insurance - employer pays 95% of premium of base HMO plan for employee (dependent coverage available for purchase).
Group dental, vision, life, and accident plans available for purchase.
Flexible Spending Account participation available.
Allows pre-tax deferrals of amounts for medical, dental or vision premiums

**After 90 days of employment - Paid Sick Leave of 5 days per year (California Residents Only).**

**After one year of service - 401K Plan Safe Harbor contribution (3% of annual earnings) received after plan year ends.