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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 where your contributions will be integral to our collective success. We cherish innovative ideas, creativity, and productivity. We seek individuals who are enthusiastic about their roles and 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 salary and compensation frameworks
  • Employee assistance program for mental health, legal inquiries, financial guidance, etc.
  • Generous paid time off and sick leave policies
  • 401k retirement plan
  • Numerous opportunities for professional growth and advancement
  • Company-sponsored events and team-building activities
  • Casual dress on Fridays

Position Summary

As a Medical Biller at AmeriPharma, your role will involve precise and prompt billing operations, including interactions with third-party payers and patients, as well as maintaining accurate financial 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 to patient accounts, ensuring completeness of benefits investigations, prior authorizations, procedure codes, diagnoses, billing units, service dates, billing charges, nursing visit notes, and supporting medical documentation.
  • Review necessary documentation such as the Financial Obligation Notification and Medicare Advance Beneficiary Notification (ABN) for completeness.
  • Accurately and timely create medical claims.
  • Add relevant per diem charges to claims as necessary.
  • Ensure the accuracy of claims regarding Place of Service.
  • Append procedure codes with appropriate modifiers when applicable.
  • Submit claims electronically and on CMS 1500 paper claim format.
  • Review patient account benefits details to confirm completeness and accuracy of coverage.
  • Ensure submission of complete and appropriate clinical documentation to justify claims medical necessity.
  • Document claim status on each patient account accurately and promptly.
  • Create and utilize reminders and follow-up reports to ensure completion of any pending activities.
  • Identify and communicate to management accounts with inadequate reimbursement rates that may require adjustments.
  • Identify and report any process inefficiencies leading to claim denials and underpayments.
  • Assist in improving communication with reimbursement staff, patients, insurance companies, and other healthcare-related parties as needed.
  • Provide exceptional customer service in addressing patient inquiries and resolving billing issues.
  • Assist in account collections activities as required.
  • Ensure compliance with all payer rules and regulations.
  • Adhere to all company policies and procedures.
  • Perform other duties as assigned.

Required Skills

  • Proficient in reading, writing, speaking, and understanding English.
  • Ability to collaborate and cooperate with team members and management.
  • Excellent time management, communication, interpersonal, multitasking, and prioritization skills.
  • Strong interpersonal abilities.
  • Capability to support colleagues in a fast-paced environment, demonstrating service orientation and social awareness.
  • Ability to work independently with minimal supervision.
  • Proficient typing skills with minimal errors.
  • Ability to read, comprehend, analyze, and interpret data.
  • Ability to apply logical thinking to a variety of problems.
  • Ability to work hours necessary to complete all projects and duties promptly.

Educational Background

  • High School Diploma.
  • Experience as a medical coder/biller with knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement is required.
  • Familiarity with ICD 10, CPT, HCPC, and J billing codes, as well as medical terminology, including CMS HCFA 1500 form and electronic billing.
  • Knowledge of Benefit Investigation and Patient Responsibility Agreements.
  • Experience with automated billing systems; CPR+ experience preferred.
  • Advanced proficiency in 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 providing the highest level of compassion and care for our patients. It is our shared responsibility to demonstrate our commitment to patients, prescribers, colleagues, and others every day.

Physical Demands

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing the duties of this job, the employee is continuously required to sit and communicate. The employee may occasionally stand, walk, use hands to handle objects, reach with hands and arms, and stoop or kneel. The employee must regularly lift and/or move up to 20 pounds and occasionally lift and/or move up to 30 pounds. Specific vision abilities required include close vision, peripheral vision, depth perception, and the ability to adjust focus.

EEO Statement

The above statements are intended to describe the work performed by individuals assigned to this position. They are not intended to be an exhaustive list of all responsibilities, duties, and skills required. The duties and responsibilities of this position are subject to change, and other duties may be assigned or removed at any time. AmeriPharma values diversity in its workforce 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.