Reimbursement Specialist ll
Reimbursement Specialist ll
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$ 29 - 33
1 Vacancy
Job Description
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.
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
We are seeking a highly organized Reimbursement Specialist II to join our dynamic team. The ideal candidate will be responsible for ensuring accurate and timely collections to maximize reimbursement which includes interactions with thirdparty payers insurance plans and patients.
Schedule Details
- Location: OnSite (Laguna Hills CA)
- Hours: Monday to Friday 8:00 AM 4:30 PM
Duties and Responsibilities
- Review patient inventory for assigned accounts.
- Verify accuracy of claims submitted and communicate with team members and management on process inefficiencies or billing errors resulting in claim denials or underpayments.
- Verify newly submitted claims status to ensure claims are on file with insurance are in process and hold payers accountable for accurate and timely reimbursement.
- Review accuracy of claim payments received from payers and patients.
- Identify and promptly communicate inadequate reimbursement rates to management potentially requiring pharmacy transfer.
- Submit appeals and pursue additional payments on medical claims denied in error or paid less than the expected reasonable maximum allowable rate for procedure codes and patient benefit levels.
- Submit negotiation letters and obtain payment resolutions from claim payers.
- Perform collections on patient balances to ensure maximum reimbursement for services provided.
- Ensure proper submission of complete clinical documentation to justify claims medical necessity.
- Independently perform claims followup and collections activities including resolving claim denials and rejections via resubmissions corrected claims and appeals following Billing Departments approved reimbursement strategies.
- Review and interpret benefit details identifying inaccuracies affecting claims reimbursement and communicate these discrepancies to the appropriate parties.
- Document claim statuses accurately and timely on each patient account (new or existing).
- Create and use reminders and followup 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 assigned account inventory.
- Provide the highest level of customer service in handling patient calls resolving billing issues and communicating with doctors 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.
- Collaborate and cooperate with other team members and management for all pharmacy needs.
- Excellent time management communication interpersonal multitasking and prioritization skills.
- Strong interpersonal skills.
- Ability to support colleagues in a fastchanging environment collaborative service oriented social perceptiveness.
- Ability to work independently with minimal guidance.
- 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.
- 23 years of collections and reimbursement experience with knowledge of managed care and commercial insurance.
- Knowledge of ICD10 CPT HCPC J billing codes and medical terminology along with CMS HCFA 1500 form & Electronic Billing.
- Familiarity with Benefit Investigation and Patient Responsibility Agreements.
- Experience with automated billing systems CPR preferred.
- Advanced proficiency in Word Excel and Outlook.
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 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 anexhaustive list of all responsibilities duties and skills required. The duties and responsibilities of this position are subject to change and otherduties 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.
Required Experience:
Senior IC
Employment Type
Full-Time
