BioMatrix Infusion Pharmacy · 1 month ago
Reimbursement Specialist
Garnet Valley, PA
Full-time
Onsite
Entry, Mid Level
$27/hr - $27/hr
2+ years expBioMatrix Infusion Pharmacy is a nationwide, independently-owned infusion pharmacy dedicated to supporting patients on specialty medication. The Reimbursement Specialist is responsible for the accurate and timely billing and reimbursement of claims, ensuring that all necessary authorizations and eligibility information are acquired and maintained.
Health CarePharmaceutical
Responsibilities
Submits accurate claims to primary and secondary insurers and resubmits accurate corrected and rejected claims in a timely manner
Acquires necessary authorizations and current eligibility information from insurance company for the dispense prior to release of delivery; communicates findings with pharmacy prior to delivery; documents notes in system
Maintains patient files with pertinent information required by insurance companies (CMN, rxs, medical records, etc.)
Prior to submitting claims, confirms that orders have been delivered verifying date of delivery
Invoices patients for patient responsibility amounts (co-pay, deductible, out-of-pocket, etc.)
Communicates with field staff as needed (new referrals, signed tickets)
Responsible for billing audits both internally and externally
Tracks each claim on a weekly basis; maintains A-R Manager report in Excel and updates each outstanding claim with a status detail note, includes insurance company’s reference number; submits report to the Director of Revenue Cycle Management; updates the claim’s billing note in CPR+ with the status detail note
Predicts cash flow from claim’s progress through insurance system
Maintains documents showing proof of communique with insurance companies, providers, etc. (i.e. email printouts, fax confirmations, FedEx tracking)
Tracks incoming checks for receipt; if issued to patient, communicates with patient or RCC to collect monies
Responds to insurance requests in a timely manner (medical records, rxs, CMNs, etc.)
Makes bank deposit and maintains accurate monthly deposit report, as needed
Verifies new patient referral information with insurance company, reports findings to Director of Revenue Cycle Management via insurance verification form
Completes insurance company contracts and/or necessary forms to maintain or become a provider
Reports unusual events or trends related to claims or insurance industry to Director of Revenue Cycle Management
Assists in insurance audits by providing all necessary billing paperwork in a timely manner
Proactively improves understanding of bleeding disorders, products and treatments; stays current on legislative changes and insurance coverages, and is capable of disseminating this information to employees, patients and others within the bleeding disorder community
Participation in QMC Quarterly Meetings, as needed
Participates in orientation, education, training programs, CE’s, literature reviews and other materials, as assigned
Completes all competence/skills billing assessments as required
Provides courteous, cooperative and timely service to patients, visitors, and staff
Participates in quality assurance activities and audits, as directed
Qualification
Required
High School Diploma or GED required
Minimum of two (2) years of medical insurance experience required
Basic computer and internet skills (e.g. Microsoft Office)
Strong customer service skills, focus and dedication
Commitment to excellent customer service and professionalism to resolve complex payer coverage issues
Preferred
Minimum of two (2) years of home infusion experience preferred
Prior experience with CPR+ and/or CareTend preferred
Certified Pharmacy Technician/License preferred, but not required
Company
BioMatrix Infusion Pharmacy
BioMatrix Infusion Pharmacy is a nationwide, independently-owned infusion pharmacy with decades of experience supporting patients on specialty medication.
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
$80M2024-06-25Acquired
2016-12-02Private Equity· $80M
Leadership Team
Kathee Kramm
President and COO
Recent News
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