About the position

The position involves managing all aspects of the revenue cycle for the post-acute patient population under the Home Infusion and Specialty Pharmacy programs. This includes billing and collections for all payers, resolving accounts, and handling appeals and grievances. The role requires collaboration with pharmacy technicians and clinical evaluators to ensure accurate patient account management and financial analysis.

Responsibilities

  • Manage all aspects of the revenue cycle for post-acute patients under Home Infusion and Specialty Pharmacy programs.
  • Handle billing and collections to all payers, including appeals and grievances.
  • Create patient accounts with appropriate demographic information and verify benefits.
  • Review medication profiles and explain copay amounts to patients prior to service.
  • Ensure accuracy of accounts monthly and at each dispense, verifying authorizations.
  • Work with pharmacists to review prescriptions and allocated per diems for services.
  • Submit weekly claims to all payers and review copay card options with patients.
  • Commence follow-up action on unpaid accounts according to payer time frames.
  • Monitor accounts using delinquency reports and special reports.
  • File appeals on non-clinical underpaid/denied claims and explain legislation impacting underpayments.
  • Trend and identify underpayment/denial issues for training purposes.
  • Ensure accurate insurance rates are loaded into the contract module for analysis.
  • Focus appeal efforts on underpayments/denials with high recovery potential.
  • Complete special projects and maintain productivity standards within department guidelines.

Requirements

  • H.S. Diploma or Equivalent
  • 5 years of experience in all areas of billing.

Nice-to-haves

  • 4 years of experience in billing in a healthcare setting.
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