GENERAL DESCRIPTION 

The collections specialist is responsible for claims submission follow-up for correct and timely payment to achieve the goal of low delinquent payer balances for all therapy types. This position is responsible for ensuring the effective and efficient management of the assigned collections / reimbursement for payors. Also, monitors collections activity and develops necessary corrective action to resolve deficiencies, denials and all unpaid open balances. Ensures all compliance, legal and regulatory requirements are met when interacting with all Internal and External customers. Ensures customer inquiries are resolved in a timely professional manner.

QUALIFICATION REQUIREMENTS

• 3-5 years’ experience in high volume pharmacy/infusion billing and collections, preferred.
• High School Diploma or equivalent
• Multiple years of experience for billing and collections
• Understanding of basic medical terminology
• Understanding and knowledge of revenue cycle, insurance billing and collections, Medicare, Medicaid, 3rd party payors.
• Understanding insurance audits, and other external actions that impact revenue
• Maintains strictest confidentiality of patient information in compliance with HIPAA and state and federal regulations
• Strong verbal and written communication skills to individuals and business at all different education levels
• Advanced computer skills and knowledge of office software packages. MS Office (Excel, Word).

QUALIFICATIONS PREFERRED

• Knowledge of Coding ICD-10, HCPCS, CPT, HER preferred, but not required.
• CPR experience not required, but a bonus.
• Bachelor’s Degree preferred, but not required.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

• Collection calls and/or correspondence to payers for status of submitted claims
• Review EOB’s for correct payment, denials, zero and short pays or additional information required to process claims
• Manage open AR for primary/secondary balances for Medicaid/MediCal and other payors if assigned to support company needs.
• Submit secondary claims, appeals for denials or short pays, appeal letters, claims review forms
• Submit a “CIF” (Claim Inquiry Form) for MediCal such as California, or other states required forms
• Accountable for reducing delinquency for assigned accounts, reducing bad debt
• Monitor overall company aging and payer specific trends reporting
• Identifies, reports and responds to overpayment requests and recoupments
• Enlist the efforts of sales and senior management when necessary to accelerate the collection process
• Utilize billing system to manage and update claims status
• Communicate & follow up with billing regarding customer accounts discrepancies and billing procedures
• Perform other assigned tasks and duties as necessary to support the Accounts Receivable Department
• Other duties as needed

NON-ESSENTIAL FUNCTIONS & RESPONSIBILITIES

• Ability to prioritize and handle multiple tasks and projects concurrently.
• Must have scheduling flexibility and be able to work overtime.
• Careful attention to detail.
• Performs related duties as requested.
• Participates in quality assurance activities and audits as directed.

KNOWLEDGE, SKILLS AND ABILITIES REQUIREMENTS

• Ability to actively communicate with all levels of staff.
• Ability to maintain accurate records and prepare reports and correspondence related to the work.
• Ability to maintain favorable public relations.
• Excellent verbal, written, and communication skills.

 Communication Skills 

• Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Participates in meetings.
• Written Communication - Writes clearly and informatively; Edits work for spelling and grammar; Varies writing style to meet needs; Presents numerical data effectively; Able to read and interpret written information.

Computer Skills 

• Become and remain proficient in all programs necessary for execution.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

• This position requires constant sitting with occasional walking, standing, kneeling or stooping.
• This position requires the use of hands to finger, handle or feel objects and the ability to reach with hands and arms.
• This position requires constant talking and hearing.
• Specific vision abilities required by this job include close vision and the ability to adjust focus.
• This position must occasionally lift and/or move up to 20 pounds
• Required to move/lift physical hardware.

AMERICANS WITH DISABILITY SPECIFICATIONS 

PHYSICAL DEMANDS 

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

OTHER 

• Will participate in legal and ethical compliance training each year.
• Will consistently behave in compliance with the BioMatrix, LLC’s legal and ethical policies and procedures.
• Will abide by the policies of BioMatrix, LLC as set forth in the Compliance Manual.
• Will not participate in any conduct considered to be unethical or illegal.

EXPECTATION FOR ALL EMPLOYEES 

Supports the organization's mission, vision, and values by exhibiting the following behaviors: integrity, dedication, compassion, enrichment and enthusiasm.

GENERAL INFORMATION: 

The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this position. They are not intended to be an exhaustive list of all duties, responsibilities, and skills required of personnel so classified.

The incumbent must be able to work in a fast-paced environment with demonstrated ability to juggle and prioritize multiple, competing tasks and demands and to seek supervisory assistance as appropriate.

Incumbents within this position may be required to assist or find appropriate assistance to make accommodations for disabled individuals in order to ensure access to the organization's services (may include: visitors, patients, employees, or others).