Denial Management Specialist- Pharmacy / Remote

Job Description

Job Description

Overview

Amerita, Inc. is a leading provider in home Infusion therapy. We are looking for a Collection Specialist to join our Revenue Cycle Management (RCM) team as we grow to be one of the top home infusion providers in the country. The Collection Specialist will report to the Collection Manager and work in our Centennial, CO office. 

Amerita is an entrepreneurial-founded company and a wholly owned subsidiary of PharMerica. The home infusion market is positioned for rapid growth driven by the aging population, increase in chronic diseases, robust pipeline of infusible drugs coming to market, and an industry shift from hospital delivery settings to lower-cost, high-quality alternative providers such as Amerita.

The Collection Specialist-Denials team is responsible for a broad range of collection processes related to medical accounts receivable in support of a single or multiple site locations. The employee will proactively work assigned accounts and denials to maximize accurate and timely payment. Above all, the Collection Specialist demonstrates exceptional internal and external customer service skills and actively promotes Amerita’s company culture.

Shift : Monday-Friday 8:30am-5:00pm

Benefits and perks for You!

• Medical, Dental, Vision insurance   
• Health Savings & Flexible Spending Accounts (up to $5,000 for childcare)   
• Tuition discounts & reimbursement   
• 401(k) 
• Company Paid Time Off*
• Shift Differential 
• DailyPay
• Pet Insurance
• Employee wellness and discount programs 

Responsibilities

As a Collection Specialist, you will...

• Ensures daily accomplishments work towards company goals for cash collections by accurately working all assigned AR over 60 days if working aging and all denied claims within 7 days of posted denial if working denials
• Understands and adheres to state and federal regulations and company policies regarding compliance, integrity, patient privacy and ethical billing and collection practices
• Research outstanding balances and takes necessary collection action to resolve in a timely manner; recommends necessary demographic changes to patient accounts to ensure future collections
• Research assigned correspondence; takes necessary action to resolve requested information in a timely manner; establishes appropriate follow up
• Resubmits accurate and timely claims in formats including, but not limited to, CMS-1500 and electronic 837
• Utilizes most efficient resources to secure timely payment of open claims or invoices, giving priority to electronic solutions
• Negotiates payment plans with patients in accordance with company collection policies
• Identifies patterns and trends of denials, short-payment or non-payment and brings them to the attention of appropriate supervisory personnel
• Reviews insurance remittance advices for accuracy. Identifies billing errors, short-payments, overpayments and unpaid claims and resolves accordingly, communicating any needed system changes
• Reviews residual account balances after payments are applied and generates necessary adjustments (within eligible guidelines), overpayment notifications, refund requests and secondary billing
• Interacts with third party collection agencies
• Communicates consistently and professionally with other Amerita employees
• Works within specified deadlines and stressful situations
• Works overtime when necessary to meet department goals and objectives

Qualifications

• High School Diploma/GED or equivalent required; some college a plus
• A minimum of one (1) year experience in medical collections with a working knowledge of managed care, commercial insurance, Medicare and Medicaid reimbursement; home infusion experience a plus
• Working knowledge of automated billing systems; experience with CPR+ preferred
• Working knowledge and application of metric measurements, basic accounting practices, ICD-9, CPT and HCPCS coding
• Solid Microsoft Office skills required, including Word, Excel and Outlook
• Ability to type 40 wpm and proficiency with 10-key calculator
• Ability to independently obtain and interpret information
• Strong verbal and written communication skills
• This position does not have supervisory responsibilities
• This position does not require travel
• While performing the duties of this job, the employee is regularly required to sit and talk or hear. The employee is frequently required to walk and use hands to finger, handle or feel. The employee is occasionally required to stand and reach with hands and arms. The employees must frequently lift and/or move up to 10 pounds and occasionally lift and or move up to 30 pounds. Specific vision abilities required by this job include close vision, distance vision and the ability to adjust focus.
• The noise level in the work environment is usually moderate

**Please note that this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice**