Billing Specialist
Elara Capital
Billing Specialist
Soleo Health
full-time
Posted on:
Location Type: Remote
Location: Remote • Texas • 🇺🇸 United States
Visit company websiteSalary
💰 $19 - $23 per hour
Job Level
Junior
About the role
- Preparation of accurate medical claims based on contracted agreements for services to various payers (e.g. Commercial Payers, Government Payers, Employer/ Institutional Payers).
- Reviewing and identifying claims pricing discrepancies based on updates/changes to fee schedules.
- Creates and submits secondary electronic pharmacy and medical claims in a timely manner.
- Billing of manufacturer copays, which includes entering the necessary information into portal or billing via paper at time of initial billing.
- Monitors billing requirements pursuant to contracts with third party payers or government programs.
- Answer insurance/billing questions from branch staff and help educate.
- Review information from electronic medical records in patient account (IE: auth, benefit verification, orders, accounts receivable, etc.) to ensure preparation and submission of clean claims.
- Perform routine revenue review of claims billed within the current month.
- Answering incoming calls and triage if necessary.
- Create claim batches and process them via electronic submission.
- Manually process any claims that are not eligible for electronic billing.
- Identify any claims that need attention, make corrections, and resubmit.
- Ensure coding to the highest level of specificity and for maximum reimbursement by third party payers.
- Daily review and follow up of unbilled delivery tickets in billing review and ready to bill queues.
- Accurately notate patient accounts to reflect all actions made including marginal, split claim notes, missing COGS, etc.
- Coordinates with the pharmacy team daily to ensure any PBM issues are addressed and resolved, accepted into revenue and billed timely.
- Effectively utilize time and resources to meet performance goals.
- Provides exceptional Customer service to internal and external customers.
- Ensures compliance with federal, state, and local governments, third party contracts, and company policies.
- Clearly communicate any billing related issues to all appropriate parties including: Intake, collections, RBL, and manager.
- Monitoring the unbilled-pending invoices queues and communicate to the branch on missing or needed documents or information.
- Maintain current knowledge of departmental and organizational policies.
Requirements
- Home infusion experience required.
- High School Diploma or equivalent.
- 1+ years’ experience in medical billing preferred.
- Knowledge of HCPC coding and medical terminology.
- Experience providing customer service to internal and external customers.
- Must be dependable.
- Excellent phone and email communication skills.
- Working knowledge of ICD10, CPT, NCCI; must be familiar with modifier application and standard billing regulations.
Benefits
- Competitive Wages
- 401(k) with a Match
- Referral Bonus
- Paid Time Off
- Great Company Culture
- Annual Merit Based Increases
- No Weekends or Holidays
- Paid Parental Leave Options
- Affordable Medical, Dental, and Vision Insurance Plans
- Company Paid Disability and Basic Life Insurance
- HSA and FSA (including dependent care) Options
- Education Assistance Program
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
medical billingHCPC codingICD10CPTNCCIclaims processingrevenue reviewfee schedule analysiselectronic claims submissionbilling regulations
Soft skills
customer servicecommunicationdependabilityproblem-solvingtime managementattention to detailteam coordinationeducational supporttriageperformance goal orientation
Certifications
High School Diploma or equivalent
