Medical Biller ll
Medical Biller ll
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$ 28 - 32
1 Vacancy
Job Description
About AmeriPharma
AmeriPharma is a rapidly growing healthcare company that offers you the opportunity to contribute to our collective success every day. We value innovation creativity and productivity and we seek individuals who are passionate about their roles and eager to grow as the company evolves.
AmeriPharmas 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 teambuilding events
- Casual Fridays
Job Summary
As a Medical Biller II at AmeriPharma you will be responsible for ensuring that all medical claims are billed accurately and promptly for services rendered to patients. The ideal candidate will be detailoriented proactive and possess a strong understanding of the billing systems used by AmeriPharma.
Schedule Details
Location: OnSite (Laguna Hills CA)
Hours: MondayFriday 8:30 AM 5:00 PM
Duties and Responsibilities
- Manage assigned invoices ensuring a Days Sales Outstanding (DSO) between 045 days.
- Maintain the Ready to Bill (RTB) status for RX and Major Medical keeping counts below 50 daily.
- Attach delivery tickets to the corresponding invoices.
- Identify denial trends and collaborate with management to address root causes.
- Provide weekly billing updates to management.
- Correct and resubmit claims that are missing or incorrectly filed; ensure submission addresses are accurate.
- Submit additional medical documentation to payers upon request.
- Stay up to date on billing guidelines for Medicare MMAPD MCOs commercial insurance and selfpay accounts.
- Validate that claims are on file and in process with the appropriate payer.
- Assist with updating contracted rates in CPR as changes occur.
- Perform billing and coding reviews to stay current with all commercial and governmental policies and procedures.
- Ensure all claims are substantiated with appropriate clinical documentation to demonstrate medical necessity.
- Accurately document claim statuses on each patients account in a timely manner.
- Use reminders and followup reports to manage pending activities.
- Communicate with management regarding accounts that require pharmacy transfers due to inadequate reimbursement rates.
- Create and submit medical claims promptly and accurately.
- Identify and report any discrepancies or errors in billing databases that may cause delays or issues.
- Add the correct procedure codes and modifiers as necessary.
- Submit claims electronically and on CMS 1500 paper claim forms.
- Review new and existing patient account benefits for completeness and accuracy.
- Ensure compliance with all payer rules and regulations.
- Adhere to all company policies and procedures.
- Perform other duties as assigned to support AmeriPharmas vision and values.
Required Qualifications
- Ability to read write speak and understand English.
- Solid understanding of medical terminology and insurance laws/guidelines.
- Ability to collaborate effectively with team members and management to meet pharmacy needs.
- Excellent time management communication interpersonal multitasking and prioritization skills.
- Strong interpersonal skills and the ability to support colleagues in a fastpaced environment.
- Strong written and verbal communication skills with excellent analytical abilities.
- Quick learner with the ability to build longterm relationships and work independently.
- Proficient typing skills with minimal errors.
- Ability to read analyze and interpret data accurately.
- Capable of applying common sense and logical thinking to resolve practical problems.
- Willingness to work hours necessary to ensure the timely completion of all tasks.
Education and Experience Requirements
- High school diploma required.
- Experience as a medical coder/biller with knowledge of managed care commercial insurance Medicare and Medicaid reimbursement.
- Familiarity with ICD10 CPT HCPCS and J billing codes as well as the CMS HCFA 1500 form and electronic billing.
- Knowledge of Benefit Investigation and Patient Responsibility Agreements.
- Experience with automated billing systems.
- Advanced proficiency in Microsoft Word Excel and Outlook.
Preferred Qualifications
- College degree.
- Medical billing certification.
- CPR experience is highly desired but not required.
AmeriPharmas 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 physical demands 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. While performing the duties of this job the employee is continuously required to sit and talk or hear. The employee is occasionally required to stand; walk; use hands to finger handle or feel objects tools or controls; reach with hands and arms; and stoop kneel crouch or crawl. The employee must regularly lift and/or move up to 20 pounds and occasionally lift/or move up to 30 pounds. Specific vision abilities required by this job include close vision peripheral vision depth perception and the ability to adjust focus.
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 based on disability or any other legally protected class.
Required Experience:
Senior IC
Employment Type
Full-Time
