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Trucept Inc. · 9 hours ago

Reimbursement/Billing Specialist

Escondido, CA

Full-time

Onsite

Mid Level

$28/hr - $28/hr

3+ years exp

Trucept Inc. is seeking a Reimbursement/Billing Specialist responsible for managing accounts receivable and overseeing the billing cycle. The role involves charge review, claims submission, follow-up, and resolving outstanding balances for pharmacy accounts.

Financial ServicesStaffing Agency

Responsibilities

Maintain a portfolio of accounts receivable for the pharmacy

Follow accounts through the Pharmacy revenue cycle, including but not limited to: verifying patient coverage information, updating registration, completing charge review, claim edits and claim submissions, and following up with third party payers and patients to facilitate prompt resolution of outstanding account balances

Communicate with Revenue Cycle teams, payors and others to resolve account problems; participate in meetings as needed to address payor concerns

Evaluate the payment status of outstanding third-party claims and resolve impediments to payment by providing information such as medical records, itemization of charges, information regarding other insurance benefits, and explanation of charges

Actively participates in both external third-party audits and in internal audits and quality improvement initiatives, maintains documentation of current workflows, assists with special projects, and works closely with third party billing teams, Dalrada Corporate Accounting teams, and with Pharmacy Department Leadership and Prior Authorization teams

Perform complex patient account follow-up activities and actively participates in quality improvement initiatives to improve accounts receivable processes

Accurate and timely processing of appeals to various pertinent payers or programs

Review and validate adjustments to accounts in the insurance portfolio based on insurance reimbursement, coverage, contracts and services provided

Review charges to ensure filing to correct guarantor (e.g. work comp vs. personal/family)

Conduct collection calls to patients with outstanding balances and negotiate full payment from patients and/or assist patients in setting up a payment plan

Provide education to patients on UW Health’s financial assistance policy and application process and direct patients to the appropriate resources as necessary (e.g. Financial Counseling, Patient Relations)

Receive, document, and respond to all patient correspondence in a prompt and courteous manner; accurately document all actions taken to reconcile outstanding balances

Assist patients in coordinating appeal processes with their insurance company

Review self-pay undistributed and credit balance accounts and provide refunds to patients as necessary

Accurately post EFT, cash and checks made payable to IV Services, LLC., to the billing system

Ensure that all transactions are completed within the appropriate guidelines, policies and regulations, typically the same day received

Process electronic remittance files, payor work queues, and generate payment reports to balance

Communicate with IV Services, LLC., staff, insurance companies, financial institution and third-party payors to resolve issues related to proper posting of payments

Complete work on special projects, queries and reports as assigned

Other duties may be assigned as needed by management

Qualification

Pharmacy billing policiesCPTICD codingCareTend pharmacy platformSpreadsheet softwareDatabase softwareAnalytic abilityCustomer satisfactionHealthcare regulationsEffective communicationInterpersonal skillsAttention to detailConfidentiality