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.

Originally posted on Himalayas