Revenue Cycle Specialist - Pharmacy Biller

Revenue Cycle Specialist - Pharmacy Biller

InfuCare Rx is a leading home infusion provider accredited by URAC and ACHC offering a specialized approach to caring for patients in need of IV therapy and specialty pharmacy services in the homecare setting. We have created an ethical, team oriented, and quality work environment for our employees that cultivates achievement and success.

As a Revenue Cycle Specialist - Pharmacy Biller, you'll take charge of multiple facets of the pharmacy/infusion reimbursement process as you interact with insurance companies and patients to ensure accurate payment. You will have the experience of investigating irregularities and resolving problems when unforeseen roadblocks arise. This is a great opportunity for an experienced professional with a track record of filing claims, billing, appeals, reviews, customer service, problem resolution and overall revenue cycle management. With InfuCare Rx experiencing rapid growth, you'll join a fluid and evolving environment that will challenge your ability to adapt but will also reward you with ample opportunities while streamlining and improving processes.

Candidates will be considered who have at least 2 years of infusion billing experience, have great customer service skills, the ability to learn/adapt, and who are excellent problem solvers. They will have the ability to lead, own the process, and be results oriented.

Responsibilities and Duties:

• Prepare and submit clean claims to assigned insurance companies, either electronically or by paper.
• Follow up on all unpaid claims in a timely manner and prepare appeal or corrected claims to ensure payment.
• Claims Submission to Medicare: preparing and submitting claims to Medicare using the appropriate coding and documentation.
• Staying updated on Medicare regulations and policies to ensure compliance for billing.
• Interacting with management, patients, and Medicare representatives to resolve issues.
• Review EOBs and act appropriately.
• Timely Receivables-Revenue Management and reporting.
• Submit write-off requests; identify bad debt as necessary.
• Identify all roadblocks which potentially could delay claims payment and be ready to discuss solutions with management.
• Bill payor plus patient responsibility amounts accurately and in a timely manner.
• Handle phone interaction with patients and insurance companies regarding billing and statement questions.
• Interpret Contracts/Maintain Payor customer service relationships in order to produce accurate claims, validate reimbursement, and keep A/R to company standards.
• Provide excellent customer service.
• Other duties as assigned

Skills/Abilities/Work Experience:

• Must have home infusion experience
• Minimum of 5 years in Medicare billing required
• Strong knowledge of government insurance plans, managed care plans, HMO/PPOs, and patient billing
• Experience with claims adjudication and calling insurance on rejected pharmacy claims
• Experience with interaction with pharmacist and intake department to resolve claims rejections
• Accurate and detail-oriented including ability to work under pressure.
• Experience with Microsoft Office (Word/Excel).
• Communicates clearly and effectively in both oral and written communications.
• Proven problem-solving and critical thinking skills.
• Hands-on experience with a computerized billing system.
• Experience with CPR+ Infusion Pharmacy software for billing highly preferred.
• Ability to self-motivate and effectively solve complex problems through internal/external interaction.
• Knowledgeable in Medicare and Medicaid guidelines for home infusion therapy.
• Knowledge of infusion billing for commercial and Medicaid payers.
• Working knowledge of infusion CPT, HCPCS and ICD-10 codes.
• Electronic claim filing
• Medical Billing compliance proficiency

Physical Demands:

Required to stand, walk, sit, talk, and hear; required to use hands to operate vehicles and office equipment; must be able to occasionally lift and/or move up to 25 lbs; specific vision requirements for this job include: close, distance and peripheral vision, and the ability to adjust focus, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of this position without compromising patient care.

InfuCare Rx is an equal opportunity employer. All employment decisions are made without regard to race, color, religion, national origin, military status, marital status, citizenship/immigration status, sex (including pregnancy and relation conditions, sexual orientation, or gender identity), age (40 and older), disability, genetic information (including employer requests for, or purchase use, or disclosure of genetic tests, genetic services, or family medical history), retaliation for filing a charge, reasonably opposing discrimination, or participating in a discrimination lawsuit, investigation, or proceeding. Background checks and drug screens are part of our hiring process. Affirmative Action/Equal Opportunity Employer, Minority/Female/Disabled/Veteran.