Reimbursement Specialist II- Remote- but must live within 1 hour of Temecula
NATURE AND SCOPE:
The Reimbursement Specialist is a pivotal position requiring excellent communication skills, independent judgment, and ability to interact with private, state and federal payer representatives, fiscal intermediaries, case managers, pharmacy partners and The Companies field personnel in the role of coordinating reimbursement from product dispensing through to completion and final resolution of the payment cycle.
Incumbent shall possess basic knowledge of reimbursement principles as well as the structure of various private, federal and state payer entities and the specific program issues related to each.
PRINCIPAL ACCOUNTABILITIES:
Submit and/or follow-up on payer claims. This may include; primary, secondary, tertiary claims and/or patient statements. Verify accuracy of payments according to the payer’s fee schedule.
Possess a basic understanding and ability to audit accounts receivables: analysis of payments, contractual discounts and/or adjustments, bad debt, recoupments, refunds and the credit/debit function.
Draft professional, concise cover letters, appeals and correspondence. This may include provider dispute forms, re-openings, reconsiderations, and various levels of appeals as necessary during the collection process.
Resolution of credit balances. This may include revenue adjustments, balance transfers, recoupments and/or refunds.
Clearly and accurately document all collection efforts within the AR system. Complete and submit monthly claim status reports.
Promptly inform management of reimbursement rates, changes, and/or issues which may directly affect The Companies® receivables.
Maintain reimbursement records in compliance with The Companies® policies & procedures.
Attend and participate in departmental meetings. Continuously strive to improve processes and service quality to internal and external customers.
Attend pertinent job-related trainings and educational seminars.
Comply with the policies and procedures stated in the Injury and Illness Prevention Program by always working in a safe manner and immediately reporting any injury, safety hazard, or program violation.
Ensure conduct is consistent with all Compliance Program Policies and procedures when engaging in any activity on behalf of the Company. Immediately report to management any concerns or violations.
Display dedication to the position responsibilities and achieve assigned goals and objectives.
Conduct special projects as requested by management.
Other duties as assigned by management.
The above statements reflect the general details considered necessary to describe the principle function of the job identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.
DIMENSION :
Supports all reimbursement activities related to a revenue base representing approximately -$200 million per year and a projected DSO of less than 40 days.
SUPERVISORY RESPONSIBILITIES:
None.
KNOWLEDGE AND SKILLS:
Basic knowledge medical reimbursement principles.
Excellent verbal and written communication skills, along with the ability to interact effectively with customers, coworkers, and all levels of management.
Ability to effectively communicate with all levels of personnel within the payer realm, including proficiency in accessing the appropriate personnel to resolve problem claims.
Ability to make independent judgments and work with minimal supervision.
Strong organizational skills and detail oriented with the ability to manage multiple assignments and responsibilities. Ability to prioritize work, work effectively, and maintain expected productivity.
Intermediate to advanced Microsoft Office skills. Basic to intermediate understanding of Internet technologies, including payer portals.
Ability to exercise discretion and maintain confidentiality to the level of required HIPAA standards.
Represent the Company in a professional manner and appearance at all times.
Understand and internalize the Company’s purpose; display loyalty to the Company and its organizational values.
Display enthusiasm and dedication to learning how to be more effective on the job and share knowledge with others.
Work effectively with co-workers, internal and external customers and others by sharing ideas in a constructive and positive manner; listen to and objectively consider ideas and suggestions from others; keep commitments; keep others informed of work progress, timetables, and issues; address problems and issues constructively to find mutually acceptable and practical business solutions; address others by name, title, or other respectful identifier, and; respect the diversity of our work force in actions, words, and deeds.
EDUCATION AND EXPERIENCE DESIRED:
High school diploma or equivalent required.
Three (3) years health care related experience i.e. DME, home care, medical insurance, or medical case management. Pharmacy or home infusion experience preferred.