Revenue Cycle Management Specialist - Billing

Overview Job Summary: The Revenue Cycle Management Specialist- Biller responsibility is to manage the process of the company's billing function including accurate and timely claim creation and submission. Responsibilities - Accurately prepare and submit claims for payment from all third-party payers in a timely manner. - Verify documentation of supplied products align with prepared claim. - Verify accuracy of billed codes and accuracy of billed and expected amounts. - Support the resolution of billing issues such as claim resubmissions to all payers, changes in coverage, and claims - Follow up on submitted claims and resolve rejected claims, including claim corrections, update payer ID, update patient insurance record, etc. - Prepare and submit patient statements. - Communicate as needed with patients about billing issues, including the results of applications for financial hardship assistance and other responses to customer inquiries about - Support accurate and comprehensive record-keeping to ensure up-to-date information is maintained and effectively shared across departments. - Assist in the implementation of processes to measure, assess, and improve the performance of the billing department activities of the company. - Ensure ongoing compliance with all laws and regulations; ensure that the department meets or exceeds accreditation standards; and implement "best practices" in all departmental - Participate in surveys conducted by authorized inspection - Participate in the company's Performance Improvement program as requested by the Performance Improvement - Participate in company committees when - Participate in in-service education programs provided by the company. - Pursue continuing education programs appropriate to job - Perform other duties as assigned by - Complete all mandatory and regulatory training programs. - Report any misconduct, suspicious or unethical activities to the Compliance - Complies with accepted professional standards and practice. Qualifications Educational Requirements: - High school diploma or GED Experience: - One to three years of experience in Home Infusion or Specialty Pharmacy billing. Job Skill Requirements: - Ability to read and interpret medical records for billing purposes. - Competent in mathematic equations. - Ability to compute unit conversions for drugs. - Understanding of CPT, HCPCS, and ICD-10 codes - Has excellent attention to detail and communication skills. - Understanding of HIPAA compliance. - Self-directed, has the ability to work with little supervision. - Proficiency in Excel, Outlook, and all other office applications. - Familiarity with pharmacy management systems (CPR+, Wellsky, and CareTend, etc.) - Familiar with billing requirements for various payers (Medicare, Medicaid, Commercial, etc.) - Knowledge and experience submitting pharmacy and medical claims electronically or on paper.

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