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Healthcare Billing Specialist

2 months ago

Laguna Hills, California, United States AmeriPharma Full time
Job Overview

Salary: $25-$28 Hourly/DOE

About AmeriPharma

AmeriPharma is a dynamic and expanding healthcare organization that fosters a culture of innovation, creativity, and productivity. We are dedicated to nurturing passionate individuals who are eager to evolve alongside the company.

Benefits Offered by AmeriPharma

  • Comprehensive benefits package including medical, dental, vision, and life insurance tailored to your needs
  • Competitive compensation and pay structures
  • Employee assistance program for mental health, legal inquiries, and financial guidance
  • Generous paid time off and sick leave policies
  • 401k retirement plan
  • Numerous opportunities for professional growth and career advancement
  • Company-sponsored events and team-building activities
  • Casual work environment on Fridays

Position Summary

As a Healthcare Billing Specialist at AmeriPharma, your primary responsibility will be to ensure precise and prompt billing processes. This includes engaging with third-party payers and patients while maintaining meticulous records.

Work Schedule

  • In-Person
  • Monday to Friday, 8:30 AM to 5:00 PM

Key Responsibilities

  • Conduct pre-billing audits to verify the accuracy of assigned payers on patient accounts, ensuring thorough benefits investigation and prior authorization
  • Review essential documentation such as Financial Obligation Notifications and Medicare Advance Beneficiary Notifications (ABN)
  • Generate medical claims with precision and timeliness
  • Incorporate necessary per diem charges into claims
  • Confirm the accuracy of claims Place of Service
  • Attach appropriate modifiers to procedure codes when necessary
  • Submit claims electronically and via CMS 1500 paper claim format
  • Examine patient account benefits to ensure completeness and accuracy
  • Ensure submission of complete clinical documentation to justify claims medical necessity
  • Document claim status accurately and promptly on each patient account
  • Create and utilize reminders and follow-up reports to complete pending activities
  • Identify and communicate accounts with inadequate reimbursement rates to management
  • Report process inefficiencies leading to claim denials and underpayments
  • Notify management of any incomplete or inaccurate billing databases causing errors
  • Facilitate communication with reimbursement staff, patients, insurance companies, and healthcare-related parties
  • Provide exceptional customer service in addressing patient inquiries and resolving billing issues
  • Assist with account collections as needed
  • Adhere to all payer rules and regulations
  • Comply with company policies and procedures
  • Perform other assigned duties as required

Required Skills

  • Proficient in reading, writing, speaking, and understanding English
  • Ability to collaborate effectively with team members and management
  • Strong time management, communication, and interpersonal skills
  • Ability to work independently with minimal supervision
  • Attention to detail and accuracy in data entry
  • Capacity to analyze and interpret data
  • Ability to manage multiple tasks in a fast-paced environment

Educational Background

  • High School Diploma
  • Experience in medical coding/billing with knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement
  • Familiarity with ICD 10, CPT, HCPC, and J billing codes
  • Understanding of Benefit Investigation and Patient Responsibility Agreements
  • Experience with automated billing systems, CPR+ preferred
  • Proficient in Microsoft Word, Excel, and Outlook

Preferred Qualifications

  • Experience with Microsoft Office/Excel: 1 year
  • Experience in Pharmacy: 1 year

AmeriPharma's Mission

Our mission is to achieve outstanding clinical and economic outcomes while demonstrating compassion and care for our patients. It is our collective responsibility to show our commitment to patients, prescribers, colleagues, and the community.

Physical Demands

The physical requirements outlined here represent those that must be met by an employee to successfully perform the essential functions of this role. Reasonable accommodations may be made for individuals with disabilities. While performing the duties of this position, the employee is regularly required to sit and communicate effectively. The employee may occasionally need to stand, walk, and use hands to handle objects or controls. The employee must be able to lift and/or move up to 20 pounds regularly and occasionally lift/move up to 30 pounds. Specific vision abilities required include close vision, peripheral vision, depth perception, and the ability to adjust focus.

Equal Employment Opportunity

The statements above are intended to describe the work performed by individuals in this role. They are not intended to be an exhaustive list of all responsibilities, duties, and skills required. The duties and responsibilities of this position may change, and additional duties may be assigned as necessary. AmeriPharma values diversity 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 disability status.