AmeriPharma · 2 hours ago
Reimbursement Specialist llI
Laguna Hills, CA
Full-time
Onsite
Mid Level
3+ years expAmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. The Reimbursement Specialist will be responsible for ensuring accurate and timely collections to maximize reimbursement through effective interactions with third-party payers, insurance plans, and patients.
Health CarePharmaceutical
Responsibilities
Reviews patient inventory of assigned accounts
Collects on all open AR inventory to ensure reimbursements are received within 60 days of billed date
Work on all correspondences assigned before due dates
Reviews contracts and fee schedules to ensure accurate reimbursements
Correlating insurance coverage with services to be provided
Preparation and review of insurance claims
In-depth understanding of healthcare billing and coding processes
Navigate complicated insurance policies and regulations
Evaluates payments received to ensure that reimbursement received is accurate
Reviews accuracy of claims submitted and communicates to team members and management on any process inefficiencies and billing errors resulting in claim denials and underpayments
Quarterly audits and reviews on open inventory
Verifies newly submitted claims status to ensure that claims are on file with insurance, in process, and hold payers accountable for accurate and timely reimbursement
Ensures that all Copay Assistant claims are billed within timely to the appropriate Foundation
Collaborate with other departments to ensure all supporting documents are on file to support our services billed
Follow up on invoices submitted to ensure prompt and timely payment
Answer incoming calls from the call center que and transfer to the appropriate department
Reviews accuracy of claim payments received from payers and patients
Identify and communicate to the management team in a timely manner on inadequate reimbursement rates that may require a pharmacy transfer
Submits appeals and pursues additional payments on any medical claims denied in error or paid less than the expected reasonable maximum allowable rate for the procedure codes submitted and level of patient’s benefit coverage
Submits letter of negotiations and obtain payment resolutions from claim payers
Performs collections on patient balances ensuring maximum reimbursement for all services provided
Ensures submission of complete and appropriate clinical documentation when justifying claims medical necessity
Independently perform claims follow-up and collections activities such as resolving claims denials and rejections through claim resubmissions, corrected claims and appeals in compliance with Billing Department’s approved reimbursement strategies in a timely manner
Effectively review and interpret benefits details and Identify and communicate on any inaccuracies in benefit details affecting claims reimbursement
Document detailed claim status on each patient’s account (new or otherwise) accurately and in a timely manner
Creates and utilizes reminders and follow up reports to ensure completion of any incomplete or pending activities
Escalates to management on any unresolved claim issues after proper claim resolution attempts that have been made
Maintains a positive DSO on assigned account inventory
Provides the highest level of customer service in answering patient phone calls and resolve patients’ questions and/or billing issues, as well as communicate with doctors’ offices and their staff
Identifies and communicates to the management team on any incomplete or inaccurate billing related databases resulting in billing errors and process delays in a timely manner
Assists in account collections activities as needed
Ensures compliance with all payer rules, regulations along with company policies & procedures
Perform other duties assigned by management
Qualification
Required
Ability to read, write, speak, and understand the English language fluently
Ability to collaborate with other team members and management for all pharmacy needs
Strong time management, communication, multitasking and organizational skills
High attention to detail and strong analytical and problem-solving skills
Ability to work collaboratively in a fast-paced team environment
Ability to work independently and meet deadlines with minimal supervision
Strong attention to detail with the ability to type accurately and analyze data
Ability to apply logical thinking to solve complex and practical problems
Flexible and able to work hours that ensure timely completion of projects and duties
High School Diploma or equivalent
Minimum of 3 years of hands-on experience in medical collections and reimbursement experience
In depth Knowledge of managed care, commercial insurance, ICD-10, CPT, HCPC codes, J billing codes, and medical terminology, along with CMS HCFA 1500 forms & Electronic Billing
Experience with Benefit Investigation and Patient Responsibility Agreements
Experience with automated billing systems, CPR+ is preferred
Advanced proficiency in Microsoft Word, Excel, and Outlook
Benefits
Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
Employee assistance program to assist with mental health, legal questions, financial counseling etc.
Comprehensive PTO and sick leave options
401k program
Plenty of opportunities for growth and advancement
Company sponsored outings and team-building events
Casual Fridays
Company
AmeriPharma
AmeriPharma has proven its dependability, commitment to improving lives, successful care optimization processes, & its ability to address.
51-200 employees
Funding
Current Stage
Growth StageLeadership Team
Andrew Allen Harper
COO
Company data provided by crunchbase