Medical Billing Collection Specialist (Amber Specialty Pharmacy)

Job Title: Revenue Integrity Analyst Department: Operations - Revenue Integrity Work Location: In-office position FLSA: Non-Exempt Additional Considerations Monday-Friday (no weekends) Hours: 8:00 a.m. - 5:00 p.m. CST Wages: Hourly $20.00-$22.00 No weekends Six paid holidays Must pass post-offer, pre-employment drug background tests as allowed by state, federal, local ordinance, statutes and licensing/accreditation requirements. General Function The Revenue Integrity Analyst will perform functions to ensure all necessary information is entered into the patient account to maximize reimbursement of all claims billed by the Company. This includes obtaining accurate insurance information using multiple methods and entering it in the correct payer sequence. The Analyst also gathers the necessary information to bill electronic NCPDP claims; reviews statements to determine accuracy; assists patients and caregivers with navigating financial assistance programs; ensures accurate correction of claims processing, whether electronic pharmacy claims or medical claims; and confirms timely delivery tickets. The goal is to make corrections, identify efficiencies, and maintain integrity of all revenue streams while communicating with coordinators, payers, and co‑workers professionally. Reporting Relations Reports to: Lead Revenue Integrity Analyst Direct Reports: N/A Primary Responsibilities This position is office‑based. Working knowledge of all necessary computer software. Contact patients to gather insurance and billing information or notify of processing delays. Contact patients and/or payers to resolve payer/coverage issues and rejections. Conduct benefits investigations and update patient accounts with accurate information. Process adjudication rejections, insurance terminations, and changes in a timely manner. Handle patient benefit statement questions to conclusion. Submit claims via electronic NCPDP clearinghouse and/or medical billing website(s). Work rejected claims in electronic NCPDP clearinghouse and/or medical billing website(s) to ensure correct receipt by payers. Collaborate to achieve company AR goals. Understand payer contracts and claim submission requirements. Bills secondary claims and ensures timely filing limits are not exceeded. Assist in reversal and rebilling of electronic NCPDP claims for corrections and proper payer adjustments (e.g., rebilling to maximize reimbursement due to AWP increases, quantity and days' supply issues, secondary, tertiary billing, reversals, payer rebilling requests). Coordinate with pharmacy on medication returns and delivery ticket assignment. Review previous days' shipments in the A/R Manager to confirm all payer opportunity has been maximized. Identify inconsistencies in billing processes and report to supervisor. Monitor Billing Review Manager and Ready to Bill Manager queues for required rebilling. Address delivery ticket assignment on partial ships and medication reshipment. Maintain current knowledge of and compliance with policies, patient confidentiality, government, insurance, and third‑party payer regulations. Run reports and analysis on current and outstanding AR; prioritize focus on accounts as directed, always focusing on oldest A/R. Professional Competencies Accomplished with MS Excel, Word, and Outlook. Self‑initiative. Demonstrated ability to meet tight deadlines. Ability to work with all levels of internal management and staff, as well as outside clients and vendors. Strong oral, written, and interpersonal skills. Attention to detail with emphasis on organizational skills. Required Qualifications One (1) year of experience billing electronic insurance claims, including Medicaid, Medicare, and Commercial insurance via NCPDP clearinghouse. Medical billing experience preferred. Working knowledge of the healthcare industry. HIPPA trained and/or the ability to work with and protect highly confidential patient and employee information. Experience working with clearinghouses for claims adjudication. Six (6) months to one year phone‑based customer service. Ability to read and interpret an Explanation of Benefits. Educational Requirements High School Diploma or equivalent. Knowledgeable in Specialty Pharmacy and Infusion Pharmacy daily operations. License or Certification Requirements None. Physical Requirements The person must move inside the office to access equipment. Constantly operate a computer and other office productivity machinery. Ability to communicate information accurately. Ability to observe details at close range. Required to stand, walk, sit, talk or hear in person and by telephone; use hands to handle objects; reach with hands and arms; regularly required to stoop, kneel, bend, and crouch with some lifting up to 15 pounds. Specific vision abilities required: close vision, distance vision, depth perception, and the ability to adjust focus to review records and documents. Working Conditions Typical indoor office environment conditions. Equipment Used to Perform the Job Computers, keyboards, mouse, monitors, fax, and/or headsets for phone work. Software specific to the position, including but not limited to Microsoft Outlook, Teams, Word, and Excel. Contacts Interact frequently with co‑workers, internal company staff, managers, leaders, insurance providers, payers, vendors, and customers. Confidentiality The incumbent must maintain the confidentiality of personal information for the applications and licensing requirements, including any financial, strategic, or proprietary information. Eligibility Requirement Candidates must be able to pass a pre‑employment drug test, background check, and health screening (if applicable). #J-18808-Ljbffr JobRx, Inc.