Reimbursement Specialist Collectors (Multiple Roles, Beverly Hills & Laguna Hills, CA)

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 team-building events
• Casual Fridays
  

Job Summary

We are seekingReimbursement Specialists from entry-level to experienced to join our dynamic team. The ideal candidate will be responsible for ensuring accurate and timely collections to maximize reimbursement experience. 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 (Beverly Hills or Laguna Hills CA)
• Hours: Monday to Friday 8am-4:30pm

Duties and Responsibilities

Entry-Level Reimbursement Specialists provide essential support in managing patient accounts and ensuring the timely recovery of payments. The primary focus of this role is administrative support for Accounts Receivable (AR) management including reviewing the patient inventory of assigned accountsand collecting on open AR inventory to meet our goal of receiving reimbursements within 60 days of the billed date.Key responsibilities involve correlating insurance coverage with services to be provided preparing and reviewing insurance claimsand ensuring that all Copay Assistant claims are billed promptly to the appropriate Foundation.This role involves general collections on patient balancesmanaging all assigned correspondence before due datesand actively assisting in maintaining a positive Days Sales Outstanding (DSO) on the assigned account inventory.

Experienced Reimbursement Specialists

Self-directed Experienced Reimbursement Specialists manage all aspects of the Accounts Receivable (AR) life cycle for assigned patient accounts. The primary objective is to maintain financial health by aggressively collecting on all open AR inventory and patient balances ensuring that reimbursements are received within 60 days of the billed date and consistently maintaining a positive Days Sales Outstanding (DSO) on the assigned account inventory. This expert role involves correlating insurance coverage with services preparing and reviewing complex insurance claims and ensuring all Copay Assistant claims are billed in a timely manner to the appropriate Foundation.

The Work Includes

Actively collecting on open AR to ensure payment within 60 days of billing managing and responding to correspondences by their due dates reviewing contracts and fee schedules for accurate reimbursement and verifying insurance coverage alignment with services provided.

Auditing open inventory verifying and following up on insurance claims and accounts receivable ensuring timely billing for Copay Assistant claims collaborating with other departments for necessary documentation and answering incoming calls.

Submitting appeals and pursuing additional payments on any medical claims denied in error or paid less than the expected reasonable maximum allowable rate for the procedure codes submitted and level of patients benefit coverage
Navigating complex insurance policies ensuring the accuracy of received reimbursement payments reviewing the accuracy of submitted claims and communicating process inefficiencies or billing errors that lead to claim denials or underpayments to team members and management.

Perform other duties 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 1 year of hands-on experience in medical coding/billing with a working knowledge of managed care commercial insurance Medicare and Medicaid reimbursement required.
• Experienced specialists will have 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 andn-depth understanding of healthcare billing and coding processes.
  • Experience with Benefit Investigation and Patient Responsibility Agreements.
  • Experience with automated billing systems CPR is preferred.
  • Advanced proficiency in Microsoft 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 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