Medical Biller

Position Title

Medical Biller/Collections

(Home Infusion Pharmacy)

Position Summary

Perform duties to process medical billing, pharmacy billing and collections with focus on accuracy, timeliness and adherence to process, to reduce denial rate, days sales outstanding (DSO), and bad debt, while guided by precedent and working within the limits of established polices.

Essential Functions

• Review patient files for completeness and accuracy, identify and audit claims, ensure all revenue opportunities are included, and complete and submit billing to payers for reimbursement, via paper claims, online pharmacy claims, and clearing house submittals.
• Review documents received including Explanation of Benefits (EOBs), Remittance Advices (RAs) and other documents indicating denials or claims acceptance. Identify reasons for denials, take required corrective action, and take ownership of claims through to timely, successful collection. Request missing EOBs or remittances from payors.
• Post cash deposits accurately and timely. Reconcile balances and post adjustments, if needed. Analyze denials, identify trends, and recommend process improvement opportunities that will result in DSO reduction, superior collection rate, reduced bad debt, and simplified processes that are responsive to the requirements of specific payers.
• Review claims with outstanding balances and identify actions to successfully collect revenues. Follow-up with insurers and patients to collect outstanding balances in a manner that ensures high level of customer service is provided to all patients. Process collections to ensure individual account records are accurate. Track Centers for Medicare and Medicaid Services (CMMS) denials and resolve issues.
• Respond to patient account inquiries and provide billing statements, payment receipts, itemized statements, and billing records as requested.
• Audit billing transactions to ensure accounts are accurate and appropriately escalated in compliance with policies and procedures. Review claims acceptance and rejection reports and perform necessary activities to correct and resubmit rejections.
• Assist pharmacy team with the submission of online adjudicated claims and help problem solve any rejected claims with the health plan.
• Assist patients with both internal and external sources of financial assistance. This includes communicating key information related to the application process, tracking renewal cycles, and sharing approval and denial information with both the patient and team members at
• Review, upload and update contracts to ensure system protocols are current. Set up new payer records.
• Support the inventory maintenance processes. Assign Healthcare Common Procedure Coding (HCPC) codes on new items and update fee schedule and wholesale prices.
• Support month-end closing and ensure all posting and billing is current and accurate.
• Perform other related duties as assigned.

Competency

• Excellent communication skills; listening, speaking, understanding, and writing English while influencing patients, care givers, payer representatives and others, answering questions and advancing reimbursement and collection efforts.
• Proven understanding of processes, systems and techniques to ensure successful billing and collection working with all payer types.
• Proven ability to identify gaps and problems from review of documentation, determine lasting solutions, make effective decisions, and take necessary corrective action.

Education/Experience Requirements

• High School Diploma or equivalent required and additional specialized training in medical billing or equivalent work experience.
• 1 to 3 years of medical billing or equivalent experience required – in an infusion setting highly preferred.
• Experience with CareTend or CPR preferred.
• Coding course certificate is highly preferred.