Financial Assistance Specialist

CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services.

Job Details:

We are seeking a dedicated Financial Assistance Specialist for our Revenue Cycle Team. In this position you will be responsible for the billing and collection of copay assistance programs and foundation claims. You will also be responsible for enrollment into these programs.

 
Responsibilities:

• Able to identify billing trends 

• Able to identify errors, correct claims and reprocess for reimbursement

• Able to read and interpret an EOB for accurate understanding of denial

• Contacts payer, or patient as appropriate

• Documents all collections activity in patient collections notes

• Documents work performed/action taken on AR Aging Report and/or Over/Under Report • Process all Payer appeal requests within the time frame required by the Payer

• Ensure the timeliness and accuracy of billing 

• Identify root cause of issues and demonstrate the ability to recommend corrective action steps to eliminate future occurrences of denials.

• Knows how to investigate claims, and reimbursement contracts

• Meet quality assurance, benchmark standards and maintain productivity levels as defined by management. 

• Performs other duties as assigned 

• Processes all approved adjustments

• Processes Home Infusion/Nursing claims

• Processes patient and insurance changes 

• Processes rejections and denials to determine if the claim needs to be refiled or submitted for an appeal with the payer

• Processes rejections for NCPDP emails to determine if the claim needs to be refiled or submitted for an appeal with the payer 

• Reviews patient information in the appropriate system to determine why the claim is unpaid, if an adjustment is valid and whether additional approval is required

• Some knowledge of copay assistance programs and foundation programs

• Understand Patient level benefits

• Understand Third Party Billing and Collection Guidelines.

Skills & Abilities 

• Ability to communicate with patients, payors, outside agencies, and public through telephone, electronic and written correspondence. 

• Background investigation (company-wide)

• Basic knowledge of Microsoft Office 

• Collections or medical billing experience with basic understanding of ICD9, CPT4, HCPCS, and medical terminology is preferred. 

• Drug screen (when applicable for the position)

• Effectively communicate in English; both oral and written, with physicians, location employees and patients to ensure questions and concerns are processed in a timely manner. 

• Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary

• Experience in medical field and administrative record management

• Familiarity with third-party payor guidelines and reimbursement practices and available financial resources for payment of balances due is beneficial

• Helpful, knowledgeable, and polite while maintaining a positive attitude 

• High school diploma or GED equivalent

• Interpret a variety of instructions in a variety of communication mediums 

• Knowledge of HCN 360 and/or CPR+ preferable

• Knowledge of Home Infusion

• Knowledge of insurance policies and requirements

• Knowledge of medical billing practices and of billing reimbursement 

• Maintain confidentiality and practice discretion and caution when handling sensitive information. 

• Medicare knowledge of billing requirements specific to DMEMAC HCN360 and CPR+ knowledge preferred

• Multi-task along with attention to detail 

• Must be able to accurately perform simple mathematical calculations using addition, subtraction, multiplication, and division 

• Must have experience processing pharmacy claims 

• One to three years of related prior work experience in a team-oriented environment

• Self-motivation, organized, time-management and deductive problem-solving skills 

• Strong customer service background Skills, Knowledge, and Abilities Ability to communicate with patients, payors, outside agencies, and public through telephone, electronic and written correspondence.

• Valid driver's license in state of residence with a clean driving record (when applicable for the position) Education and/or Experience High school graduate or equivalent

• Work independently and as part of a team Collections or medical billing experience with basic understanding of ICD9, CPT4, HCPCS, and medical terminology is preferred

Qualifications

• High school graduate or equivalent. Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary. 

• High school diploma or GED equivalent 

• One to three years of related prior work experience in a team-oriented environment 

• Experience in medical field and administrative record management 

• Strong customer service background 

Employment is contingent on:

• Background investigation (company-wide) 

• Drug screen (when applicable for the position) 

• Valid driver's license in state of residence with a clean driving record (when applicable for the position)

CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.