CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services.

Job Details:

We are seeking a dedicated Medical Billing Specialist for our Revenue Cycle Team. In this position you will be responsible for resolving escalation requests for the billing and or collection of insurance claims. 

 
Responsibilities 

Ensure the timeliness and accuracy of escalation requests and resolution

Understand Third Party Billing  

Identify root cause of issues and demonstrate the ability to recommend corrective action steps to eliminate future occurrences of denials. 

Meet quality assurance, benchmark standards and maintain productivity levels as defined by management 

Processes patient and insurance changes 

Processes rejections for NCPDP emails to determine if the claim needs to be refiled or submitted for an appeal with the payer 

Able to identify billing trends 

Performs other duties as assigned 

Skills & Abilities 

Must have experience processing medical and pharmacy claims 

Ability to communicate with patients, payors, outside agencies, and public through telephone, electronic and written correspondence 

Effectively communicate in English; both oral and written, with physicians, location employees and patients to ensure questions and concerns are processed in a timely manner 

Helpful, knowledgeable, and polite while maintaining a positive attitude 

Interpret a variety of instructions in a variety of communication mediums 

Knowledge of Home Infusion  

Knowledge of insurance policies and requirements 

Knowledge of medical billing practices and of billing reimbursement 

Maintain confidentiality and practice discretion and caution when handling sensitive information 

Multi-task along with attention to detail 

Must be able to accurately perform simple mathematical calculations using addition, subtraction, multiplication, and division 

Self-motivation, organized, time-management and deductive problem-solving skills 

Work independently and as part of a team 

Collections or medical billing experience with basic understanding of ICD-10, CPT4, HCPCS, and medical terminology is preferred

Familiarity with third party payor guidelines and reimbursement practices and available financial resources for payment of balances due is beneficial. 

Basic knowledge of Microsoft Office 

Knowledge of HCN 360 and/or CPR+ preferable  

Medicare knowledge of billing requirements specific to DMEMAC

Qualifications

High school graduate or equivalent. Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary. 

High school diploma or GED equivalent 

One to three years of related prior work experience in a team-oriented environment 

Experience in medical field and administrative record management 

Strong customer service background 

Employment is contingent on:

Background investigation (company-wide) 

Drug screen (when applicable for the position) 

Valid driver's license in state of residence with a clean driving record (when applicable for the position)

CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country.