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. Compensation: Up To $27.00 Per Hour Based Upon Experience Final compensation offer to candidate may vary based upon work experience, education, and/or skill level. For additional information regarding compensation and benefits, e-mail us at Careers@BioMatrixsprx.com Schedule & Location: 9am Eastern Standard Time - 6pm Eastern Standard Time It is anticipated that an incumbent in this role will work onsite in one of the locations noted in the posting. Work location is subject to change based on business needs. Job Description: The Reimbursement Specialist is responsible for the accurate and timely billing and reimbursement of claims. |
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QUALIFICATION REQUIREMENTS |
- High School Diploma or GED required
- Minimum of two (2) years of medical insurance experience required
- Basic computer and internet skills (e.g. Microsoft Office)
- Strong customer service skills, focus and dedication.
- Commitment to excellent customer service and professionalism to resolve complex payer coverage issues
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QUALIFICATIONS PREFERRED |
- Minimum of two (2) years of home infusion experience preferred
- Prior experience with CareTend preferred
- Certified Pharmacy Technician/License preferred, but not required
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ESSENTIAL FUNCTIONS AND RESPONSIBILITIES |
Billing Responsibilities - Submits accurate claims to primary and secondary insurers and resubmits accurate corrected and rejected claims in a timely manner.
- Acquires necessary authorizations and current eligibility information from insurance company for the dispense prior to release of delivery; communicates findings with pharmacy prior to delivery; documents notes in system.
- Maintains patient files with pertinent information required by insurance companies (CMN, rxs, medical records, etc.).
- Prior to submitting claims, confirms that orders have been delivered verifying date of delivery.
- Invoices patients for patient responsibility amounts (co-pay, deductible, out-of-pocket, etc.).
- Communicates with field staff as needed (new referrals, signed tickets).
- Responsible for billing audits both internally and externally.
Collections Responsibilities - Tracks each claim on a weekly basis; maintains A-R Manager report in Excel and updates each outstanding claim with a status detail note, includes insurance company’s reference number; submits report to the Director of Revenue Cycle Management; updates the claim’s billing note in CPR with the status detail note.
- Predicts cash flow from claim’s progress through insurance system.
- Maintains documents showing proof of communique with insurance companies, providers, etc. (i.e. email printouts, fax confirmations, FedEx tracking).
- Tracks incoming checks for receipt; if issued to patient, communicates with patient or RCC to collect monies.
- Responds to insurance requests in a timely manner (medical records, rxs, CMNs, etc.)
- Makes bank deposit and maintains accurate monthly deposit report, as needed.
Insurance Responsibilities - Verifies new patient referral information with insurance company, reports findings to Director of Revenue Cycle Management via insurance verification form
- Completes insurance company contracts and/or necessary forms to maintain or become a provider.
- Reports unusual events or trends related to claims or insurance industry to Director of Revenue Cycle Management.
- Assists in insurance audits by providing all necessary billing paperwork in a timely manner.
- Proactively improves understanding of bleeding disorders, products and treatments; stays current on legislative changes and insurance coverages, and is capable of disseminating this information to employees, patients and others within the bleeding disorder community.
- Participation in QMC Quarterly Meetings, as needed.
- Participates in orientation, education, training programs, CE’s, literature reviews and other materials, as assigned.
- Completes all competence/skills billing assessments as required.
- Provides courteous, cooperative and timely service to patients, visitors, and staff.
- Participates in quality assurance activities and audits, as directed.
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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.
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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. |
