Collection Group Leader- Infusion Pharmacy

Job Description

Job Description

Overview

Amerita, Inc. is a leading provider in home Infusion therapy. We are looking for an RCM Team Lead to join our Revenue Cycle Management team as we grow to be one of the top home infusion providers in the country. The Team Lead 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 Team Lead will be capable of performing and monitoring all activities related to the collection of all Accounts Receivable and denials including but not limited to Medicare, Medicaid, commercial insurances, and patient balances. The Collection Group Leader will be the initial resource for questions from other collectors within the department. The Collection Group Leader will proactively work assigned accounts to maximize accurate and timely payment. The Collection Group Leader will work closely with collectors and with other management to identify and share information about trends or patterns in denials and payment activity. The Collection Group Leader will assure that the collection department maintains compliance with company policies and all applicable laws and regulations regarding billing, collections, banking and the security of patient financial information. Above all else qualified candidates should possess exceptional internal and external customer service and communication skills and promote company culture.

Responsibilities

As a Collection Group Leader, you will...

• Ensures that daily accomplishments work towards company goals for cash collections by ensuring all AR over 60 days is accurately worked by aging teams and all denied claims are worked within 7 days of posted denial for denials team.
• Assists the process of collections through AR analysis and denial resolution as well as assist with the receiving, batching, posting, balancing and archiving payments and adjustments to accounts receivable
• Assures collection department complies with established company criteria for timeliness and accuracy of billing and collections
• Researches denials and outstanding balances and takes necessary collection action to resolve in a timely manner; makes necessary demographic changes to patient accounts to insure future collections
• Utilizes most efficient resources to secure timely payment of open claims or invoices; electronic solutions should be given priority
• Reviews insurance remittance advices for accuracy. Identifies billing errors, short payments, over payments, 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 notification, refund request, and/or secondary billing as needed
• Monitors payer websites regularly for updates and communications accordingly; makes recommendations to changes in billing procedures to insure timely payment of claims
• Review and Post adjustments within eligible range of $499.00 and under
• Identifies inefficient processes; makes recommendations to automate or eliminate
• Identifies denial trends and patterns of short-payment, overpayment or non-payment and brings them to the attention of appropriate specialist
• Performs QA audits for proper management of A/R and evaluation of collector performance
• Contacts payers by telephone, mail, email or other appropriate means to secure copies of missing remittance documents as needed
• Monitors the adherence to state and federal regulations, to company policies regarding compliance, integrity, patient privacy and ethical billing and collection practices
• Assist in implementation of training program for Collection Specialists and Patient Collection Specialists
• Coordinates and conducts training for all new staff
• Assists with competency testing for all training materials
• Interacts with third party collection agencies as needed
• Understands and adheres to HIPAA and PHI guidelines
• Communicates clearly and professionally, both in written form and orally, with internal and external customers
• Available to work extended hours when necessary to meet department deadlines
• Performs other tasks or special projects as requested by management

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**