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Billing Clerk / Specialist
Oakland Gardens, NY

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Total Care Rx

Billing Specialist

Job Description

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

Benefits

  • Paid Time Off (PTO)
  • 401(k) Plans
  • Health Insurance
  • Dental Insurance