RCM Collections Specialist II

About River’s Edge Pharmacy:
River’s Edge Pharmacy has become a leader in infusion therapy services. Administered by specially trained infusion nurses, these services are provided at standalone locations, physicians’ offices. Each location provides individualized care in a private setting for procedures including IVIG, Hemophilia, Chemotherapy, TPN, and Pain Management.

The River's Edge Story:
River’s Edge Pharmacy started in Rancho Mirage, CA in 2008 to address the need for compassionate care by specialty pharmacies. In 2013, the Company moved to a larger facility in Palm Desert, CA.

The successful execution of River’s Edge Pharmacy’s growth strategy led to the opening of a total of nine infusion locations and two pharmacies in California.

Since the expansion, River’s Edge Pharmacy has become the specialty pharmacy and infusion service provider of choice for patients and physicians seeking exceptional expertise, human kindness, and professional guidance.

The team of pharmacists, technicians, and care experts at River’s Edge Pharmacy serve as patient advocates by combining professional expertise with caring support. These services are all part of River’s Edge Pharmacy’s commitment to helping patients live better lives while navigating the complicated world of medicine and health insurance.

Position Overview:
Responsible for a broad range of collection processes related to medical account receivable in support of a single or multiple site locations.

• Ensure daily accomplishments work towards company goals for cash collections and Account Receivable over 90 days.
• Understand and adhere to state and federal regulations and company policies regarding compliance, integrity, patient privacy and ethical billing and collection practices.
• Research outstanding balances and take necessary collection action to resolve in a timely manner; recommend necessary demographic changes to patient accounts to ensure future collections.
• Research assigned correspondence; take necessary action to resolve requested information in a timely manner; establish appropriate follow up.
• Resubmit accurate and timely claims in formats including, but not limited to, CMS-1500 and electronic 837.
• Utilize the most efficient resources to secure timely payment of open claims or invoices, giving priority to electronic solutions.
• Negotiate payment plans with patients in accordance with company collection policies.
• Identify patterns of short-payment or non-payment and bring them to the attention of appropriate supervisory personnel.
• Review insurance remittance advices for accuracy. Identify billing errors, short-payments, overpayments and unpaid claims and resolve accordingly, communicating any needed system changes.
• Review residual account balances after payments are applied and generate necessary adjustments (within eligible guidelines), overpayment notifications, refund requests and secondary billing.

Plus – may perform other duties as assigned.

Education:

• High School Diploma or equivalent required

Experience:

• 3 - 5 years of experience in medical collections with a working knowledge of managed care, commercial insurance, Medicare and Medicaid reimbursement; home infusion experience a plus
• Working knowledge of automated billing systems; experience with CPR /Mediware software preferred
• Working knowledge and application of metric measurements, basic accounting practices, ICD-9, CPT and HCPCS coding

Behavioral Competencies:

• Excellent verbal and written communication skills. 
• Excellent interpersonal, negotiation, and conflict resolution skills.
• Excellent organizational skills and attention to detail.
• Strong analytical and problem-solving skills.
• Ability to prioritize tasks and to delegate them when appropriate.
• Ability to act with integrity, professionalism, and confidentiality.  

 Working Conditions:

• Standard office/hybrid environment.
• Occasional travel within Southern California may be required.
• Full-time position with standard business hours; flexibility to work additional hours during peak periods is expected.

Confidential Information:

This position has access to confidential information such as patient information and company information.

Compensation:

Pay range (DOE): $26 - $30 / hour

Actual base pay could vary based on factors including but not limited to experience, subject matter expertise, geographic location where work will be performed, and the applicant's skill set. The base pay is just one component of the total compensation package for employees. Other rewards may include an annual cash bonus and a comprehensive benefits package.

Benefits:

• Health insurance
• Dental insurance
• Vision insurance
• Life insurance
• Flexible spending account
• Health savings account
• 401(k) matching
• Employee Assistance Program
• Paid sick time
• Paid time off
• Wellness program
• Education program

Equal Opportunity Employer:
We are an equal opportunity employer committed to diversity and inclusion. We celebrate diversity and are dedicated to fostering an inclusive environment for all employees

Salary : $26 - $30