The Reimbursement Specialist (Infusion) position assists with all patient billing and collections. in all office functions necessary for the accurate and timely billing and collection of patient accounts including reconciling accounts , assembling information for various reports, resubmitting any necessary documentation and bringing discrepancies and problems to the attention of the Reimbursement Supervisor.
- This position reports to Hetty Lima , Vice President , Specialty Infusion Services.
- There are no direct reports to this position.
certification or training in the field of pharmacy, experience in Accounts Receivable and
- Education: High School Diploma or G.E.D required. Some college education,
Accounting is preferred.
o Knowledge of Third Party Payers including Medicaid, Medicare Commercial, medical terminology and coding experience.
- Experience: Three to five years minimum experience in claim submission, medical billing. Medical billing and/or case management negotiation experience preferred.
o Familiar with medical terminology, ICD-9, and HCPC codes required. General knowledge of diagnosis , therapies, and services provided.
o Strong customer service background.
o Must be detail-oriented and be able to multi-task.
o Be able to work well with various personalities and work as a team.
o Should be independent and self-motivated - able to work and accomplish goals with little to no supervision.
o Should be organized and able to prioritize and manage time effectively. o Must be dependable and maintain levels of confidentiality.
o General knowledge of Internet navigation and research, e-mail , fax
transmission, and copy equipment are essential.
- Physical : Walking, sitting, standing , kneeling, crouching and stooping.
- Mental: Basic math skills with the ability to compile , graph, and track different aspects of company information. Computer aptitude.
- language: Fluency in English with outgoing personality that translates to phone skills with excellent verbal and written communication skills.
- Reasoning: Ability to apply common sense understanding to carry out instructions furnished in written , oral or diagram form.
- Technology: Proficient in Windows based operating systems and Microsoft Office programs including Word, Excel, and Outlook.
A climate controlled office and store environment.
DUTIES & RESPONSIBILITIES
Coordination of all insurance and patient billing issues including:
- Electronic billing.
- Commercial billing not done electronically.
- HIPAA compliancy issues with regard to billing.
- Insurance Verifications prior to providing services.
- Billing chart monitoring and maintenance.
- Claims resubmission and coordination of staff for required appeals documentation.
- Follow-up with insurances when claims are not paid in a timely or satisfactory manner.
- Issuance of patient invoices monthly.
- Posting cash , Explanation of Benefits , rejections to patient profile.
- Addressing patient billing inquiries and resolving billing issues.
- Updating staff on changes in billing procedures and documentation requirements.
- Run "End of Day Report" daily.
- Installation of CPR+ updates as they become available.
- Resolution of computer problems with appropriate support staff.
- Participate in the Sales and Marketing process through good customer relations practices.
- Help to create a positive and comfortable experience for clients Diplomat serves.
- Make sure patient's computer profiles and billing charts are QA with every new intake/referral order and that changes or additions are current and up to date.
- Other Duties and Responsibilities as assigned.
Diplomat Specialty Pharmacy - 2 years ago