PBM Billing 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 Medical Billing Specialist for our Revenue Cycle Team. In this position you will be responsible for the billing and or collection of insurance claims. 

 
Responsibilities 

• Understand Third Party Billing

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

• Ensure the timeliness and accuracy of billing 

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

• Processes patient and insurance changes 

• Processes Home Infusion/Nursing claims

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

• Able to identify billing trends 

• Performs other duties as assigned 

Skills & Abilities 

• Must have experience processing pharmacy benefit claims 

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

• 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. 

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

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

• 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. 

• Multi-task along with attention to detail 

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

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

• 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. 

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

• Basic knowledge of Microsoft Office 

• Knowledge of HCN 360 and/or CPR+ preferable

• Medicare knowledge of billing requirements specific to DMEMAC

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.