Key Facts

Remote From:

Full time

Mid-level (2-5 years)

English

Hard Skills

Accounts Receivable Claims And Litigation Management Medical Abbreviations ICD Coding (ICD-9/ICD-10) Reimbursement Regulations CPT Coding Claims And Litigation Management Medical Expense Performance Reporting Systems Benefits Administration Performance Management +1 more

Other Skills

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Professional Communication
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Professionalism
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Analytical Skills
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Time Management
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Customer Service
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Detail Oriented
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Problem Solving

Roles & Responsibilities

2-3 years accounts receivable experience in a physician office setting
Previous Buy and Bill experience preferred
General knowledge of HCPCS, CPT-4 and ICD-10 coding and/or medical terminology
High School Diploma/GED

Requirements:

Manage accounts receivable for buy-and-bill pharmacy, including professional, governmental/non-governmental, denied, aged, high-priority and high-dollar claims, and document activity per policies.
Verify patient benefits and eligibility for buy-and-bill drugs, obtain required authorizations, submit claims, and track status while following up on denials or pending items.
Communicate professionally with payer resources via portals, email, and phone; interpret payer guidelines and contractor variances; address claim edits and rejections.
Prepare and submit appeal letters for technical denials, provide supporting documentation, track appeal resolutions, and assist with co-pay assistance applications as applicable.

Job description

Crossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

Since 2005, Crossroads has been at the forefront of treating patients with opioid use disorder. Crossroads is a family of professionals dedicated to providing the most accessible, highest quality, evidence-based medication assisted treatment (MAT) options to combat the growing opioid epidemic and helping people with opioid use disorder start their path to recovery. This comprehensive approach to treatment, the gold standard in care for opioid use disorder, has been shown to prevent more deaths from overdose and lead to long-term recovery. We are committed to bringing critical services to communities across the U.S. to improve access to treatment for over 26,500 patients. Our clinics are all outpatient and office-based, with clinics in Georgia, Kentucky, New Jersey, North and South Carolina, Pennsylvania, Tennessee, Texas, and Virginia. As an equal opportunity employer, we celebrate diversity and are committed to an inclusive environment for all employees and patients.

Day in the Life of an Authorization Specialist - Buy and Bill Pharmacy

Performs all duties and responsibilities in accordance with local, state, and federal regulations and company policies.
Utilize and apply industry knowledge to resolve new and aged accounts receivables by working various account types, including but not limited to professional claims, governmental and/or non-governmental claims, denied claims, aged accounts, high priority accounts, high dollar accounts, reimbursements, credits, etc.
Leverage available resources and systems (both internal and external) to analyze patient accounting information and take appropriate action for payment resolutions, document all activity in accordance with organizational and client policies.
Communicate professionally (in all forms) with payer resources to include websites/payer portals, e- mail, telephone, customer service departments, etc.
Maintain quality and productivity results at a level that meets departmental standards as measured by a daily/weekly/monthly average.
Verify patient benefits and eligibility for buy and bill drugs
Obtains authorization for buy and bill drugs as required by the various payors
Submit claims to insurance companies for buy and bill drug administration and related services.
Track claim status and follow up on denials or incomplete/pending claims
Apply on behalf of patient for co-pay assistance program as applicable
Ability to interpret payer clinical guidelines and identify contract variances affecting reimbursement.
Demonstrate clear proficiency in third-party billing requirements to include federal, state, and commercial/managed care payers.
Interpret claim scrubber edits/rejections and takes appropriate action necessary to resolve issues.
Seek resolution to problematic accounts and payment discrepancies.
Prepare appeal letters for technical denials by accessing specific payer appeal forms, submitting appropriate medical documentation and tracking appeal resolution.
Other Duties as Assigned.

Education and Experience requirements

Must have had at least 2-3 years accounts receivable experience in a physician office setting.
Has previous Buy and Bill experience preferred
General Knowledge of HCPCS, CPT-4 and ICD-10 coding and/or medical terminology.
Familiar with multiple payer requirements and regulations for claims processing.
Must have a High School Diploma/GED

Position Benefits

Have a daily impact on many lives.
Excellent training if you are new to this field.
Mileage reimbursement (if applicable) Crossroads matches the current IRS mileage reimbursement rate.
Community events that promote belonging and education. Includes but not limited to community cook outs, various fairs related to addiction treatment and outreach, parades, addiction awareness for schools, and holiday events.
Opportunity to save lives everyday!