What are the responsibilities and job description for the Lead Billing Specialist position at BioMatrix Specialty Pharm?
INTRODUCTION
Company Overview:
BioMatrix is a nationwide, independently-owned infusion pharmacy with decades of experience supporting patients on specialty medication. Our compassionate care team helps patients navigate the often-challenging healthcare environment. We treat our patients like family and get them started on therapy quickly. We work closely with them as well as their family and their healthcare providers throughout the patient journey, staying focused on optimal clinical outcomes.
At BioMatrix the heart of our Inclusion, Diversity, Equity, & Access (IDEA) philosophy is the commitment to cultivate a welcoming space where everyone’s contributions are acknowledged and celebrated. Our goal is to draw in, develop, engage, and retain talented, high-performing individuals from diverse backgrounds and viewpoints. We believe that both respecting and embracing diversity enriches the experiences and successes of our patients, employees, and partners.
Location:
It is anticipated that an incumbent in this role will work onsite in the Kansas City/Overland Park, KS-area. Work location is subject to change based on business needs.
Job Description:
The Lead Billing Specialist will oversee and ensure the accuracy and timeliness of the company's billing functions, and resolve billing discrepancies, while also ensuring adherence to payor guidelines and regulatory requirements.
QUALIFICATION REQUIREMENTS
- High school diploma or GED required
- Minimum of two (2) years of past working experience in billing related activities required
- Basic computer and internet skills (e.g. Microsoft Office)
- Strong customer service skills, focus and dedication
QUALIFICATIONS PREFERRED
- Experience in Home Infusion medical billing and pharmacy adjudication preferred
- Certified Pharmacy Technician/License preferred, but not required
- Health promotion/maintenance experience preferred, but not required
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
Billing Responsibilities:
- Lead and mentor the billing specialists, providing guidance, training, and feedback.
- Ensure accurate and timely creation of new claims, review electronic claims, and manage the "ready to bill" queues.
- Maintain accurate records, ensure submitted claims meet payor guidelines, and resolve billing discrepancies.
- Identify and address the root causes of claim denials, implement strategies to reduce denial rates, and appeal denied claims.
- Have a thorough understanding of payer contracts.
- Knowledge of insurance verification and reimbursement processes.
- Address customer inquiries and resolve billing discrepancies, providing excellent customer service to both internal and external stakeholders.
- Stay updated on relevant billing regulations, coding guidelines, and payer requirements, ensuring compliance with all applicable standards.
- Familiarity with clearinghouses and the billing functionality.
- Assist with various data entry, administrative, and clerical tasks.
KNOWLEDEGE, SKILLS AND ABILITIES REQUIREMENTS
- Ability to maintain competence for current position.
- Ability to maintain accurate records and prepare reports and correspondence related to the work.
- Ability to perform work within specified time frames and adapt positively to frequent interruptions and changes in workload and/or work schedule.
- Strong customer service skills, focus and dedication.
- Excellent interpersonal and organizational skills.
- Ability to set priorities and solve problems.
- Excellent verbal, written, and communication skills.
- Ability to respond quickly to emergency requests.
- Self-motivated, self-reliant and team oriented.
Communication Skills
- Oral Communication - Speaks clearly and persuasively in positive or negative situations; listens and gets clarification; Responds well to questions; Demonstrates group presentation skills; 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 is all programs necessary for execution of the position.
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
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. If needing a reasonable accommodation within the application process, please contact the BioMatrix People & Culture team at Careers@BioMatrixsprx.com or 954.385.7322 x 1425.
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, places patients first, is all-in with stacked-hands, and is focused on relentless consistency wins.
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).
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
