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JumpStart Games · 8 hours ago

CHEMOTHERAPY REVENUE REIMBURSEMENT SPECIALIST - FULL TIME

Lakeland, FL

Full-time

Onsite

Senior Level

6+ years exp

JumpStart Games is seeking a Chemotherapy Revenue Reimbursement Specialist to manage billing and reimbursement processes. The role involves following up on claims, resolving disputes, and ensuring compliance with medical billing guidelines.

3D TechnologyChildrenEducationFamilyGamingMobileSoftware

Culture & Values

Responsibilities

Follow up on open claims in accordance with established guidelines

Review claims for completeness and compliance with billing guidelines

Works to resolution disputes and appeals of third-party denials

Identifies, reviews, and contests denials and inappropriate payments

Documents actions taken within the system

Possesses a comprehensive understanding of Clinic contracts, carrier specific, State or Federal governmental, CMS, or CPT billing and reimbursement guidelines, to include NCCN and FDA guidelines

Reviews bulletins, updates, etc., maintains guidelines as reference/resource material to assist in follow-up

Responsible for auditing all chemotherapy/Nurse run payments to ensure they are correct, and appeal claims as necessary

Acts as liaison to the Chemotherapy/Nurse Run Department to ensure any special projects and requests are completed efficiently and correctly

Accesses available third-party and governmental on-line services

Accesses appropriate web sites to obtain current carrier guidelines, verify eligibility and re-files claims

Possesses a comprehensive understanding of how to enter insurance information into the billing system

Reviews and edits registration information according to Clinic policy

Remain current on new FSC's that are created and understand how they are used

Qualification

Claims adjudicationCPT codingICD-10 codingMedical terminologyWindows applicationsTyping speed 40 wpmOrganizational skillsProblem-solving skillsCommunication skills

Required

High School graduate or equivalent

6 years in a medical business office or related field

Experience with the claim's adjudication process for multiple governmental agencies and private insurance carriers

Basic medical terminology

Current CPT and ICD-10 coding experience

An aptitude to retain detailed information

Ability to be multi-tasked oriented, to prioritize and to produce an acceptable volume of work

Excellent organizational and problem-solving skills

Excellent communication skills, oral and written

Basic knowledge of Windows-based computer applications

Accurate typing rate of 40 wpm

Ability to operate the following equipment: computer, copier, fax, and 10-key calculator

Preferred

AA degree or minimum of 2 years' experience with retail pharmaceutical disruption as well as an understanding of units of measure with drug distribution

A knowledge of drug uses based on clinical DX