Reimbursement Specialist ll

About AmeriPharma

AmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. We like people who are passionate about their roles and people who like to grow and change as the company evolves.

AmeriPharma’s Benefits

• Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
• Great pay and general compensation structures
• Employee assistance program to assist with mental health, legal questions, financial counseling etc.
• Comprehensive PTO and sick leave options
• 401k program
• Plenty of opportunities for growth and advancement
• Company sponsored outings and team-building events
• Casual Fridays

Job Summary

We are seeking a highly skilled Reimbursement Specialist to join our dynamic team. The ideal candidate will be responsible for ensuring accurate and timely collections to maximize reimbursement experience, with the ability to process a minimum of 32 claims per day while maintaining high levels of accuracy and productivity. This role is essential in ensuring accurate and timely collections and maximizing reimbursement through effective interactions with third-party payers, insurance plans, and patients. The candidate will possess strong analytical skills, be detail-oriented, and excel in submitting claims, appeals, and resolving discrepancies with minimal supervision.

Schedule Details

• Location: On-Site (Laguna Hills, CA)
• Hours: Monday to Friday, 8:00 AM - 4:30 PM

Duties and Responsibilities

• Review and manage patient inventory for assigned accounts.
• Verify accuracy of claims and address any process inefficiencies or billing errors contributing to  denials or underpayments.
• Confirm claims are on file with insurance, and are in process with payers, to ensure accurate and timely reimbursement.
• Analyze claim payments from payers and patients for discrepancies.
• Communicate underpayments or inadequate reimbursement rates to management
• Submit appeals and pursue additional payments on denied or underpaid medical claims
• Submit negotiation letters and resolve payment issues with payers.
• Perform patient balance collections to ensure maximum reimbursement
• Ensure proper clinical documentation is submitted to support medical necessity.
• Conduct claim follow-ups and rework denials through corrected claims, and appeals.
• Identify benefit inaccuracies affecting claims reimbursement, and communicate findings.
• Accurately document all claim statuses and update in patient records. 
• Create and use reminders and follow-up reports to ensure completion of pending activities.
• Escalate unresolved claim issues to management after proper resolution attempts.
• Maintain a positive DSO (Days Sales Outstanding) on all assigned accounts 
  
• Provide excellent customer service when handling patient inquiries, resolving billing issues, and communicating with physician offices and staff. 
• Identify and communicate any issues with incomplete or inaccurate billing databases leading to errors or delays.
• Assist in account collections activities as needed.
• Ensure compliance with payer rules, regulations, and company policies and procedures.
• Perform other duties as assigned by management.
  

Required Qualifications

• Ability to read, write, speak, and understand the English language fluently. 
• Ability to collaborate with other team members and management for all pharmacy needs. 
• Strong time management, communication, multitasking and organizational skills. 
• High attention to detail and strong analytical and problem-solving skills.
  
• Ability to work collaboratively in a fast-paced team environment.
• Ability to work independently and meet deadlines with minimal supervision.
• Strong attention to detail with the ability to type accurately and analyze data.
• Ability to apply logical thinking to solve complex and practical problems.
• Flexible and able to work hours that ensure timely completion of projects and duties.
  

Education and Experience Requirements

• High School Diploma or equivalent.
• Minimum of 3 years of hands-on experience in medical collections and reimbursement experience. 
• In depth Knowledge of managed care, commercial insurance,  ICD-10, CPT, HCPC codes, J billing codes, and medical terminology, along with CMS HCFA 1500 forms & Electronic Billing.
• Experience with Benefit Investigation and Patient Responsibility Agreements.
• Experience with automated billing systems, CPR+ is preferred.
• Advanced proficiency in Microsoft Word, Excel, and Outlook.
  

AmeriPharma’s Mission Statement 

Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients. It is our joint and individual responsibility daily to demonstrate to outpatients, prescribers, colleagues, and others that We Care!

Physical Requirements 

The following physical activities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions and expectations

EEO Statement 

The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The duties and responsibilities of this position are subject to change and other duties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, age, protected veteran status, or on the basis of disability or any other legally protected class.