Infusion Billing Specialist at Barnes Healthcare Services in Valdosta, Georgia

Job Description:

This new opportunity is a dual role.  The Infusion Billing Specialist has the primary responsibility of efficient and effective account receivable billing and collections. This position will assist the Revenue cycle Director in developing the PBM claims side of the business in addition to assisting the pharmacies in claims payment issues. This may include prescriptions, letters of medical necessity, CMN’s, invoices, EOMB’s, remittances, checks, vouchers, and electronic versions of the same documents.

The Infusion Billing Specialist focuses on individual processes such as:

• Billing and collecting for NCPDP payers


• Denials - involved in the processing of denials by insurance companies.


• Collections - collect all monies due in a timely manner.


• Quality Assurance - audit and confirm work orders and supporting documentation into the billing system in a timely manner, to ensure maximum reimbursement for services rendered.


• The position is measured on amounts of accounts receivable, % over 90 days, and DSO.

• Clean claim filing


• B v D claims processing

ESSENTIAL FUNCTIONS:

• Be willingly involved in cross-training, when possible.


• Complete prescription intake process including verification of insurance coverage of PBM claims.


• Contact patients to set up or reschedule the delivery and update appropriate staff.


• Continually audit patient files and maintain corresponding documentation necessary to defend third-party audits and maintain payer and company compliance.


• Correctly determine patient responsibility by verifying quantities and prices for drugs/services billed.

• Ensure A/R reflects the appropriate amount expected from the insurance carrier.

• Enter all documentation in the computer system accurately on a daily basis accurately as required.


• May require cross-training in other areas of the pharmacy.


• Notates/Collects copayments for NCPDP claims. Transmit individual credit card payments as needed.

• Perform other duties as assigned by management.


• Performs test claims and adjudication of claims promptly based on dispenses for 3 pharmacy locations in Georgia and assists in Florida as needed.


• Prepare reports, as assigned by supervision. Utilize computer-generated reports to monitor and maintain appropriate billing practices and to help identify and resolve issues in billing and collections.


• Review Pharmacy order and label verifying that the billing information matches dispense prior to submission of the claim.


• Review rejected claims and takes necessary steps to finalize claim, including re-verification of insurance, obtaining prior authorizations, contacting payor, physician offices & patients.


• Take initiative in finding ways to contribute to the organization.


• Timely and accurate submission of claims. Responsible for accurate submission of the necessary documentation to the insurance companies with claims.


• Timely submission of clean claims to the designated payer.


• Understand the terms and fee schedule for all contracts for which invoices are submitted. 


• Verify patient eligibility, prescription benefits, input insurance into the system, or look up missing insurance information and preparation and submission claims to insurance companies; commercial, Medicare, Medicaid, and other third-party payers


• When necessary, provide assistance to others when workloads increase.

Qualifications

• Able to handle multiple tasks in a stressful environment


• Ability to work independently and deliver to deadlines


• Ability to solve problems with minimal direction


• Ability to excel in a fast-paced, team-oriented environment working on multiple tasks simultaneously, while adhering to strict deadlines


• Good communication skills.


• Good computer skills and Great attention to detail and accuracy.


• Knowledge of medical terminology.


• Three-year experience in billing, cash posting, or collection procedures, preferably in healthcare.


• Quality-minded; motivated to seek out errors and inquire when something appears inaccurate.


• Long-term care or retail pharmacy technician or billing experience preferred.

REQUIRED EDUCATION/TRAINING AND/OR PROFESSIONAL EXPERIENCE:

• High School Diploma or Equivalency

Benefits:

Health Insurance, Dental Insurance, Vision Insurance, TeleDoc services, 401K Retirement with Match, Short Term Disability, Long Term Disability, Life Insurance, Employee Assistance Program, Fifteen Days of Vacation yearly (accruing upon your start date), 2 floating holidays, Six paid Company Holidays, Forty hours of paid Community Service yearly, Annual Organizational Performance bonus, Four Company Events per year (Pending COVID Restrictions).

Barnes is an Equal Opportunity Employer