Reimbursement Specialist

Job Description

Job Description

Description :

The Reimbursement Specialist is responsible for assisting the Reimbursement Supervisor in all areas of Collection and Billing.

Please be aware that this position requires full-time, in-office work.

Duties and Responsibilities

• Follows appropriate payer requirements, policies and procedures when billing for products, care and services.
• Will always maintain 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.
• Ensure timely follow-up of assigned accounts and escalate 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+ ensure AR is accurately notated and follow up date scheduled.
• Answer phone lines in a timely manner, responding appropriately to questions and information received.
• Handles faxes as appropriate and as applicable.
• Backup as needed for Patient Services.
• Participate in surveys conducted by authorized inspection agencies.
• Participate in the pharmacy's Performance Improvement program as requested by the Performance Improvement Coordinator.
• Participate in pharmacy committees when requested.
• Participate in in-service education programs provided by the pharmacy.
• Report any misconduct, suspicious or unethical activities to the Compliance Officer.
• Respond to payer pre and post payments audits timely. Work closely with Compliance to ensure proper information is sent.
• Perform other duties as assigned by Supervisor.

Schedule

Monday through Friday 8 : 30 am to 5 : 00 pm

Requirements :

• Minimum two years' experience in the Reimbursement field.
• Minimum two years’ experiences 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.

EEO Statement

We are committed to fostering a diverse and inclusive workplace. As an Equal Employment Opportunity (EEO) employer, we ensure that all employment decisions are based on merit, qualifications, and business needs.

We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected status.

We provide a work environment free from discrimination and harassment, and we celebrate diversity by creating an inclusive environment for all employees.