Ability to resolve cash posting issues and research unapplied cash accounts. Review, audit, research and resolve all unapplied cash amounts. Need experience identifying and correcting some complex posting issues that have resulted in unapplied payments. Complete refunds requested by Insurance Reimbursement Specialists. Complete reposting of misapplied payments and correct transfers of patient copays as requested by Insurance Reimbursement Specialists. Participate and provide input to periodic Process Evaluation and Improvement meetings. Provide support to the Team and Department Management. Other tasks as directed by management.
• Prepares and reviews claims to ensure billing accuracy according to payor requirements, including but not limited to codes, modifiers, pricing, dates and authorizations
• Pursues collection activities to obtain reimbursement from payers and/or patients
• Frequent follow up with payers and/or patients on outstanding accounts
• Escalates delinquent and/or complex claims to Lead Reimbursement Specialist for appropriate action.
• HS Degree (or equivalent). Some college or technical training preferred
• Two Years experience in P.B.M. environment is helpful, but not required. Prior Reimbursement (Billing/Collection) experience preferred.
• Strong data entry and 10-key skills
• Retail pharmacy, customer service experience helpful but not required
• PC and MS Office literate
• Strong attention to detail
• Excellent retention and judgment ability
• Proficient written and oral communication skills
• Ability to work in fast-paced, production environment
• Reliable, self motivated with excellent attendance
• Team player who has the ability to stay on task with little supervision