Full Time 40 hours Grade 008 Pharmacy SMH Responsibilities Position Summary: Under the supervision of the billing/intake manager, responsible for home infusion charging and payment reconciliation processes and procedures with the primary focus on billing/collections and compliance with payer standards including Medicare and other third party payers. Ensures proper coding of claim submissions to payer requirements, and works to monitor payments and resolve any third party issues. Expected to work independently and resolve and troubleshoot complex issues. Responsibilities Billing Third party billing Properly code claims for payment based on requirements from government and commercial payers to ensure prompt payment Reconcile commercial Medicaid / Medicare claim payments Analyze, resolve, and resubmit rejected/underpaid claims for payment Correspond with insurance and patients related to billing Resubmit denied claims with any required information Prepare and send claims on a defined schedule Problem Solving Identify proactively problems with billing, payment or collections and resolve as needed Participate in multidisciplinary teams for problem solving Accurately handle deposits as needed Contact manager when assistance is needed when solution is beyond expertise or authority Work in conjunction with pharmacy finance to ensure accounts receivable balances are accurate and payment are applied correctly Other Responsibilities Manage special payer projects with management staff to ensure proper reimbursement per contracts or patient benefit Participate in payer audits and collect, summarize and send requested information Coordination with other finance staff for regularly scheduled reports or needed information Maintain and develop software billing templates Requirements: Associate's degree in Business Administration and 2 years of hospital patient accounting or consumer collections experience, or certification obtained from a nationally accredited billing program (i.e., Certified Medical Billing Specialist CMBS, Certified Medical Records Technician CMRT, Certified Medical Reimbursement Specialist CMRS); or an equivalent combination of education and experience. Ability to work as a team or independently in a high pace environment. Initiative, independent thinking and decision making skills are a must. Prefer 3 years of experience in hospital pharmacy, including experience in area of training. Experience in home infusion billing or hospital infusion center billing preferred. Ability to use Microsoft Office Suite products (Excel, Word, SharePoint, Access) preferred. Maintain compliance with University/Departmental Policies.
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