Lead Payment Recovery Specialist

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

The Lead Payment Recovery Specialist (LPRS) is responsible for managing the Appeals Refunds and Reconciliation Process related to patient refunds offsets and recoupments. The LPRS will handle communications with government health plans commercial medical plans and other entities that reimburse Ameripharma for services and supplies provided to their members.

Schedule Details

• Location: Laguna Hills CA
• Hours: Monday Friday 8:00 AM 4:30 PM (Flexible)

Duties and Responsibilities

• Track monitor and manage all correspondence related to patient refunds offsets and recoupments.
• Appeal dispute or process refund requests for amounts paid by health plans for services provided by Ameripharma.
• Analyze requests using internal documentation and notes. Leverage payer remittance notices checks EFTs and banking information to support decisionmaking.
• Ensure timely posting of offsets to prevent duplicate work.
• Submit refund requests with supporting documentation when refunds are warranted by the paying entities.
• Maintain balanced tracking of all offset requests ensuring accurate reporting.
• As the lead provide all necessary information and instructions to various teams and departments regarding refunds and offsets.
• Serve as the primary point of contact for internal or external audits providing all required information.
• Regularly update and provide assessment reports on all offset and refund requests.
• Utilize MS Excel for required reporting and status tracking.
• Offer clear and detailed instructions to team members regarding refunds offsets and recoupments.
• Supervise the daily work of team members offering guidance instructions and training as needed.
• Ensure all refund offset and recoupment requests are properly documented in the EDI system.

Required Qualifications

• Proficient in reading writing speaking and understanding English.
• Ability to interpret and reconcile remittance notices.
• Collaborative and cooperative with team members and management to support pharmacy needs.
• Strong time management communication interpersonal multitasking and prioritization skills.
• Excellent interpersonal skills with a strong analytical background.
• Ability to support colleagues in a fastpaced everchanging environment; serviceoriented with high social perceptiveness.
• Capable of working independently with minimal guidance.
• Strong typing skills with minimal errors.
• Proficient in reading analyzing and interpreting data.
• Ability to apply logical thinking and common sense to a wide range of intellectual and practical problems involving both abstract and concrete variables.
• Availability to work hours necessary to complete all projects and duties in a timely manner.

Education and Experience Requirements

• High school diploma required.
• 35 years of experience in revenue cycle management preferably in a specialty pharmacy or home infusion setting.
• Knowledge of managed care commercial insurance and government programs.
• Familiarity with automated billing systems; experience with CPR is 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