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Healthcare Billing Specialist
2 months ago
About Us:
At Ajinomoto Cambrooke, we are dedicated to enhancing the health of individuals through innovative nutritional therapies.
Founded by parents seeking better solutions for children with PKU, we have expanded our focus over the years to include various therapeutic areas, emphasizing enjoyable nutrition as a key element in improving the lives of those with medical conditions.
Joining our team means becoming part of a diverse group of talented individuals committed to building fulfilling careers while positively impacting society.
We value candidates who possess an entrepreneurial spirit, a proactive approach, and a problem-solving mindset.Our work environment is built on mutual respect and collaboration, providing you with opportunities for personal and professional growth.
We invite you to experience a rewarding career that allows you to excel and make a difference in the lives of our patient communities.
Position Overview:
The Medical Billing and Collections Specialist II plays a vital role in supporting the Finance department with various responsibilities related to the billing and collection processes of customer accounts.
This role also serves as a patient-focused liaison, assisting customers in accessing our products through the referral process.
The ideal candidate will demonstrate professionalism while interacting with patients, insurance providers, healthcare institutions, and Cambrooke employees. The MBCS II will be responsible for researching, collecting, and sharing third-party payer information pertinent to claim adjudication and denial management.
Qualifications:
Education and Experience:
Minimum of a High School Diploma or equivalent; a college degree is advantageous.
At least 5 years of experience in medical billing, eligibility verification, authorization processes, and payer interactions. Experience with Durable Medical Equipment (DME) is preferred.
Comprehensive understanding of third-party payer regulations, including contracts and agreements.
Familiarity with claim and denial procedures of third-party payers.
Knowledge of HCPCs and ICD10 coding is beneficial.
Understanding of medical terminology and clinical nutrition is a plus.
Skills and Abilities:
Proficient in Microsoft Office applications, including Excel, Word, and Teams.
Experience with SalesForce or order management systems is preferred but not mandatory.
Ability to manage multiple tasks with attention to detail to ensure accuracy.
Strong organizational skills with the capability to prioritize tasks and adapt to interruptions seamlessly.
Excellent written and verbal communication skills are essential for providing outstanding customer service and revenue cycle updates.
A demonstrated sense of compassion and commitment to ensuring patients and their families receive optimal coverage for Cambrooke products.
Must be a collaborative team player, engaging with various Revenue Cycle Teams and effectively communicating and mentoring others.
Must possess excellent listening skills to collaborate with team members, colleagues, and external customers to identify and implement suggestions, guidance, and resolutions.
Assist in training and quality assurance for new staff members.
Knowledge of HIPAA regulations and the ability to maintain confidentiality regarding proprietary company information is essential.
Working Conditions:
Environment:
Most work is conducted in an office setting within a controlled temperature environment. Occasional outdoor work may be necessary to support employee events.
May involve activities in environments with hazardous elements, requiring adherence to safety policies and guidelines.
Physical Requirements:
This position requires the ability to sit for extended periods, typically a minimum of 6 hours daily.
Regularly required to stand, walk, bend, and reach overhead.
Occasional lifting or carrying of up to 25 pounds and repetitive use of hands and arms for tasks such as writing, filing, and computer work.
Key Responsibilities:
Ensure that Ajinomoto Cambrooke has the necessary documentation to submit to third-party payers.
Communicate with healthcare professionals, state agencies, and insurance providers to obtain clinical documents, eligibility information, authorizations, and other necessary items to facilitate payment.
Timely invoicing for patient balances and institutional orders.
Conduct collection calls with payers and institutions until payment or resolution is achieved.
Understand and document payer denials to enable assigned specialists to appeal as necessary based on payer guidelines.
Collaborate with Client Services, Reimbursement Team, Sales, and Territory Managers to resolve or prevent issues while providing updates.
Work with Client Services and Reimbursement team members to address payment issues and ensure prior orders are processed as outlined in agreements.
Ensure all incoming requests are addressed and responded to promptly, following the guidelines established within the Revenue Cycle Department.
Possess knowledge of Pharmacy Benefits and Durable Medical Equipment companies to ensure patients and their families can access the necessary formula and medical foods based on their insurance coverage.
Familiarity with the CambrookeCare process to assist in explaining benefits and claims processing based on established contracts.
Manage cash receipts and prepare deposits.
Assist in preparing financial applications for patients facing financial difficulties.
Participate in month-end and year-end closing and reporting activities.
Maintain medical records in compliance with HIPAA regulations.
Adhere to all departmental and company standard operating procedures regarding quality and safety.
Other duties as assigned.
Salary Range:
$33.00 per hour
EEO Statement:
Ajinomoto Cambrooke, Inc. is an Equal Opportunity Employer committed to fostering a diverse workforce.
