Job Responsibilities:

• Process follow ups with payment and collections
• Manages Medicare, Medicaid, and commercial billing processes and procedures including but not limited to eligibility, remittance, and appeals.
• Ensure Medicaid, Medicare, 3rd Party & Home Health Agency billing is up to date.
• Daily communication with insurance carriers verbally, on-line and in writing to obtain payment for DME claims, exhibit sound understanding of 3rd Party billing & reconciliation, and capability of executing same without supervision or follow-up.
• Post all necessary Medicaid & Medicare information into pharmacy operating system for proper documentation.
• Contact patients daily regarding reimbursement information and account balances.
• Charge credit cards and schedule patients on a monthly payment plan.
• Review AR aging reports and follow up.
• Maintain patient records consistently and accurately with necessary documentation.
• Assurance that outstanding claims do not exceed 90 days.
• Research & resolve Medicaid and/or Medicare denials and rejections.
• Troubleshoot complicated pharmacy claim issues and coordinates with payers on reimbursement issues.
• Ensure claims are paid in a timely manner and do not exceed days, following necessary revenue cycle processes.
• Operational aspects including performance improvement initiatives, and overall workflow management.
• Answer calls regarding Medicaid, Medicare, commercial insurances, & 3rd Party reimbursement, etc.
• Review Pharmacists prescriptions to ensure prescribed items are covered by CMS or appropriate 3rd party payer.
• Paper Billing of primary and secondary pharmacy claims.
• Reconcile outstanding receivable for DME products.

Job Requirements:

• Extensive knowledge of Medical insurance with Medicare B & Third-Party payment systems.
• Detail oriented with the ability to multi-task & work with all levels of management and staff.
• Commitment to follow-up and ability to efficiently complete tasks by assigned deadlines.
• Experience with Microsoft office programs. (Word, Excel, Outlook, PowerPoint, Teams)
• Ability to maintain efficient record keeping systems and procedures.
• Knowledge of local, state, federal billing regulations and legal requirements pertaining to Medicare and Medicaid claims.
• Ability to prepare and analyze detailed reports as needed. Excellent interpersonal skills.

Preferred:

Knowledge specific to pharmacy reimbursement: state, federal and commercial.

preferred:

knowledge in micromerchant and QS1

• on site position only, no remote
• M-F 9am-530pm.

Job Type:

Full-time Pay:

$25.00

• $30.

00 per hour

Benefits:

401(k) Dental insurance Employee discount Health insurance Paid time off Vision insurance

Education:

High school or equivalent (Preferred)

Experience:

Medicare billing: 4 years (Required) DME billing: 3 years (Required)

Work Location:

In person