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:
The Team Lead, Billing is responsible for managing third-party billing and collections, ensuring timely and accurate billing of claims. This role involves billing medical and NCPDP claims, identifying and resolving root cause of rejections, with the goal of resolving discrepancies and maximizing reimbursement. The ideal candidate will have knowledge of home infusion, medical billing practices, and payer reimbursement guidelines, as well as strong communication and problem-solving skills. The position requires attention to detail, the ability to work independently, and proficiency with Microsoft 365. Experience with ICD-10, CPT-4, HCPCS, and Medicare billing is preferred.
Responsibilities
Manage all fiscal functions necessary to ensure the prompt and correct payment of all monies owed by both insurers and patients
Answer billing and insurance inquiries on patient accounts from patients, insurance companies and other departments
Knowledgeable and responsible for multiple payers
Maintain, correct, and reconcile batch posting for any or all payers as requested by the Supervisor
Prepare adjustments that are necessary to change existing accounts receivable to update patient information
Review billing edit report to identify and perform data edits needed to ensure that claims are submitted to the correct payer and that all required information is included
Submit claims to appropriate insurance carriers or organizations to obtain payment for services provided
Utilize billing software to confirm orders for billing
Assist all front-line workers with questions/issues
Primary trainer for all new employees and any existing employees who are learning a new function
Assist Supervisor and Manager with making sure all current priorities and initiatives are being followed
Manage billing projects to ensure timely completion
Monitor unbilled to ensure old batches are worked as priority
Work with Supervisor/Manager to ensure the end of month is done in a timely manner
Be SME(Subject Matter Expert) for all payers
Skills & Abilities
Strong customer service and interpersonal skills
Effective written and verbal communication
Excellent organization, problem solving skills and attention to detail
Meet the quality assurance and benchmark standards set by the management team
Knowledge of patient accounting systems, third party billing and collections guidelines
Ability to communicate with patients, payers and outside agencies through telephone, electronic and written correspondence
Requirements
Associate degree preferred
Medical billing experience with an understanding of ICD10, HCPCS and medical terminology is preferred
Familiarity with third party payer guidelines, reimbursement practices and available financial resources is preferred
Knowledge of Medicare guidelines for Home Infusion
Proficiency in the Microsoft Suite
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.