Billing Specialist

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 Billing Specialist is responsible for managing and processing third-party billing to ensure timely and accurate reimbursement for home infusion and nursing services. This role involves handling patient and insurance changes, processing claims, and addressing rejections while maintaining productivity and quality assurance standards. The ideal candidate will possess strong knowledge of medical billing practices, insurance policies, and home infusion, along with excellent communication and organizational skills.

Responsibilities

• Understand Third Party Billing.
• Ensure the timeliness and accuracy of billing.
• Meet quality assurance, benchmark standards, and maintain productivity levels as defined by management.
• Identifies patient and insurance changes.
• Processes Home Infusion/Nursing claims.
• Processes rejections for NCPDP claims 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

• Ability to communicate with patients, payors, outside agencies, and public through telephone, electronic and written correspondence.
• 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 ICD910, CPT4, HCPCS, and medical terminology is preferred.
• Basic knowledge of Microsoft Office.
• Knowledge of HCN 360 and/or CPR+ preferable.
• Medicare knowledge of billing requirements specific to DMEMAC.

Requirements

• 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.

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.