Reimbursement Specialist

2 weeks ago

Orange, California, United States BMR Partners Inc Full time
Job Summary

We are seeking a highly skilled Reimbursement Specialist to join our team at BMR Partners Inc. The successful candidate will be responsible for assisting the Reimbursement Supervisor in all areas of Collection and Billing.

Key Responsibilities
  • Follows appropriate payer requirements, policies, and procedures when billing for products, care, and services.
  • Maintains the confidentiality of patients/customers and their personal information.
  • Responsible for timely and accurate claim submission to all payers.
  • Performs billing, collection, scanning, filing, and audit functions as needed.
  • Ensures timely follow-up of assigned accounts and escalates issues to Supervisor/Director as needed.
  • Notifies the appropriate person/department when missing data or documentation is not able to be obtained and is delaying the billing function.
  • Monitors account receivable balances in CPR+ and ensures AR is accurately notated and follow-up date scheduled.
  • Answers phone lines in a timely manner, responding appropriately to questions and information received.
  • Handles faxes as appropriate and as applicable.
  • Backs up as needed for Patient Services.
  • Participates in surveys conducted by authorized inspection agencies.
  • Participates in the pharmacy's Performance Improvement program as requested by the Performance Improvement Coordinator.
  • Participates in pharmacy committees when requested.
  • Participates in in-service education programs provided by the pharmacy.
  • Reports any misconduct, suspicious, or unethical activities to the Compliance Officer.
  • Responds to payer pre and post payments audits timely. Works closely with Compliance to ensure proper information is sent.
  • Performs other duties as assigned by Supervisor.
Requirements
  • Minimum two years' experience in the Reimbursement field.
  • Minimum two years' experience in Collections, required.
  • Knowledge of the terms and understanding associated with day-to-day functions of a reimbursement specialist.
  • Must be able to multi-task, prioritize, and be detail-oriented.
  • Must be able to work independently and be willing to assist in other areas of the department as needed.
  • Knowledge of insurance and specialized functions of billing and reimbursement, required.
  • Must possess excellent oral and written communication skills, with the ability to express technical issues in 'layman' terms.
  • Fluency in a second language is a plus.
  • Must be friendly, professional, and cooperative with a good aptitude for customer service and problem-solving.
  • Organizational skills sufficient to maintain consistently accurate records.
  • Open to possible overtime due to department demands.
Education and Experience Requirements
  • High School Diploma or Graduation Equivalent Diploma (G.E.D)
  • Prior experience in a pharmacy or home health company.
Physical Requirements

Employees in this role must meet certain physical demands to perform the essential functions effectively. Reasonable accommodations will be provided for individuals with disabilities to ensure they can perform these functions.

This position involves frequent sitting and requires the ability to communicate effectively through talking and listening. Occasionally, the role requires standing, walking, and using hands to operate objects, tools, or controls.

The employee may also need to reach with arms and engage in physical activities such as bending, kneeling, or crouching.

Regularly, the employee must lift and move items weighing up to 20 pounds, with occasional lifting of items up to 50 pounds.

Visual requirements include the ability to focus, as well as maintain peripheral vision and depth perception.

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