Revenue Cycle Management Specialist - Billing

Overview

Job Summary: The Revenue Cycle Management Specialist- Biller responsibility is to manage the process of the company's billing function including accurate and timely claim creation and submission.

Responsibilities

• Accurately prepare and submit claims for payment from all third-party payers in a timely manner.
• Verify documentation of supplied products align with prepared claim.
• Verify accuracy of billed codes and accuracy of billed and expected amounts.
• Support the resolution of billing issues such as claim resubmissions to all payers, changes in coverage, and claims
• Follow up on submitted claims and resolve rejected claims, including claim corrections, update payer ID, update patient insurance record, etc.
• Prepare and submit patient statements.
• Communicate as needed with patients about billing issues, including the results of applications for financial hardship assistance and other responses to customer inquiries about
• Support accurate and comprehensive record-keeping to ensure up-to-date information is maintained and effectively shared across departments.
• Assist in the implementation of processes to measure, assess, and improve the performance of the billing department activities of the company.
• Ensure ongoing compliance with all laws and regulations; ensure that the department meets or exceeds accreditation standards; and implement "best practices" in all departmental
• Participate in surveys conducted by authorized inspection
• Participate in the company's Performance Improvement program as requested by the Performance Improvement
• Participate in company committees when
• Participate in in-service education programs provided by the company.
• Pursue continuing education programs appropriate to job
• Perform other duties as assigned by
• Complete all mandatory and regulatory training programs.
• Report any misconduct, suspicious or unethical activities to the Compliance
• Complies with accepted professional standards and practice.

Qualifications

Educational Requirements:

• High school diploma or GED

 

Experience:

• One to three years of experience in Home Infusion or Specialty Pharmacy billing.

 

Job Skill Requirements:

• Ability to read and interpret medical records for billing purposes.
• Competent in mathematic equations.
• Ability to compute unit conversions for drugs.
• Understanding of CPT, HCPCS, and ICD-10 codes
• Has excellent attention to detail and communication skills.
• Understanding of HIPAA compliance.
• Self-directed, has the ability to work with little supervision.
• Proficiency in Excel, Outlook, and all other office applications.
• Familiarity with pharmacy management systems (CPR+, Wellsky, and CareTend, etc.)
• Familiar with billing requirements for various payers (Medicare, Medicaid, Commercial, etc.)
• Knowledge and experience submitting pharmacy and medical claims electronically or on paper.