Offer summary

Qualifications:

High school diploma or GED equivalent is required., One to three years of related work experience in a team-oriented environment is preferred., Experience in processing pharmacy benefit claims and knowledge of insurance policies is essential., Strong customer service skills and effective communication abilities are necessary..

Key responsabilities:

Responsible for billing and collection of insurance claims.

Identify root causes of billing issues and recommend corrective actions.

Ensure timely and accurate billing while meeting quality assurance standards.

Process patient and insurance changes, including handling rejections and appeals.

Job description

We are seeking a dedicated PBM Billing Specialist for our Revenue Cycle Team. In this position you will be responsible for the billing and or collection of insurance claims.

Responsibilities

Understand Third Party Billing
Identify root cause of issues and demonstrate the ability to recommend corrective action steps to eliminate future occurrences of denials.
Ensure the timeliness and accuracy of billing
Meet quality assurance, benchmark standards and maintain productivity levels as defined by management.
Processes patient and insurance changes
Processes Home Infusion
Processes rejections for NCPDP emails to determine if the claim needs to be refiled or submitted for an appeal with the payer
Able to identify billing trends
Performs other duties as assigned

Skills & Abilities

Must have experience processing pharmacy benefit claims
Ability to communicate with patients, payors, outside agencies, and public through telephone, electronic and written correspondence.
Effectively communicate in English; both oral and written, with physicians, location employees and patients to ensure questions and concerns are processed in a timely manner.
Helpful, knowledgeable, and polite while maintaining a positive attitude
Interpret a variety of instructions in a variety of communication mediums
Knowledge of Home Infusion
Knowledge of insurance policies and requirements
Knowledge of pharmacy billing practices and of billing reimbursement
Maintain confidentiality and practice discretion and caution when handling sensitive information.
Multi-task along with attention to detail
Must be able to accurately perform simple mathematical calculations using addition, subtraction, multiplication, and division
Self-motivation, organized, time-management and deductive problem-solving skills
Work independently and as part of a team
PBM billing experience with basic understanding of ICD9, CPT4, HCPCS, and medical terminology is preferred.
Familiarity with third party payor guidelines and reimbursement practices and available financial resources for payment of balances due is beneficial.
Basic knowledge of Microsoft Office
Knowledge of HCN 360 and/or CPR+ preferable

Qualifications

High school graduate or equivalent. Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary.
High school diploma or GED equivalent
One to three years of related prior work experience in a team-oriented environment
Experience in medical field and administrative record management
Strong customer service background

Employment is contingent on:

Background investigation (company-wide)
Drug screen (when applicable for the position)
Valid driver's license in state of residence with a clean driving record (when applicable for the position)

Required profile