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Billing Clerk / Specialist
Oakland Gardens, NY
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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)