CarepathRx transforms hospital pharmacy from a cost center into an active revenue generator through a powerful combination of technology, market-leading pharmacy services and wrap-around services. Job Details: Responsibilities Understand Third Party Billing and Collection Guidelines. Identify root cause of issues and demonstrate recommendations for corrective action steps to eliminate future occurrences of denials. Meet a higher level of quality assurance, benchmark standards, and maintain productivity levels as defined by management. Contact payer, or patient as appropriate. Documents all collections activity in patient collections notes. Documents work performed/action taken on AR Reports. Process all Payer appeal requests within the time frame required by the Payer. Reviews claim processing to determine proper payment has been issued. Request and process all approved adjustments. Processes rejections and denials to determine if the claim needs to be refiled or submitted for an appeal with the payer. Reviews patient information in appropriate system to determine why the claim is unpaid, if an adjustment is valid, and whether additional approval is required. Ability to identify errors, correct claims and reprocess for reimbursement. Ability to read and interpret an EOB for accurate understanding of claim processing. Knowledge of claims investigation and reviewing payer contracts for reimbursement. Performs other duties as assigned. Skills & Abilities Ability to communicate with patients, payors, outside agencies, and public through telephone, electronic and written correspondence. Helpful, knowledgeable, and polite while maintaining a positive attitude. Interpret a variety of instructions in a variety of communication mediums. Knowledge of Home Infusion. Knowledge of insurance policies, reimbursement practices, as well as claim processing requirements. Knowledge of medical billing practices and of medical billing reimbursement. Maintain confidentiality and practice discretion and caution when handling sensitive information. Multi-task along with attention to detail. Ability to accurately perform simple mathematical calculations using addition, subtraction, multiplication, and division. Self-motivation, organized, time-management and deductive problem-solving skills. Work independently and as part of a team. Collections or medical billing experience with basic understanding of ICD10, CPT4, HCPCS, and medical terminology is preferred. Familiarity with third party payor guidelines and reimbursement practices and available financial resources for payment of balances due is beneficial. Medicare knowledge of billing requirements specific to DMEMAC. HCN360 and CPR knowledge preferred. Knowledge of Microsoft 365 products, including but not limited to Outlook, Teams and Excel. Strong customer service skills. Requirements High school graduate or equivalent. Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary. CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. We maintain a drug-free work environment. Applicants must be eligible to work in this country. CarepathRx is transforming pharmacy care delivery for health systems and hospitals, delivering improved patient outcomes that drive clinical, quality and financial results. Through the industry’s most comprehensive, end-to-end hospital pharmacy care delivery model, CarepathRx is turning hospital pharmacy into an active care management strategy and revenue generator while providing support across the patient’s complete healthcare journey. The company takes an enterprise approach, providing a powerful combination of technology, market-leading clinical pharmacy services, and wrap-around services that optimize pharmacy performance across the enterprise for fully integrated pharmacy operations, expanded healthcare services, improved ambulatory access, minimized clinical variation and new health system revenue streams. Today, CarepathRx serves more than 15 health systems and 600 hospitals, with more than 2,400 employees nationwide. For more information about CarepathRx, visit our website. We are always searching for the best talent to join our growing organization. Check out our available opportunities by using the search functionality and filtering options at the top! CarepathRx offers full-time employees a comprehensive benefits package that includes: Paid Company Holidays Paid Time Off and Volunteer Time Off Medical, Dental and Vision Benefits for you and your family 401(k) with Company Match Company-paid Life Insurance and Disability Benefits Supplemental Insurance packages Don't see an open opportunity that matches your skill set just yet? Please click Get Started below or click Introduce Yourself in the top right corner of the page to share your information with us. We will reach out when something becomes available! Additionally, create an account with CarepathRx Careers to set up Job Alerts if something becomes available that peaks your interest! To create an account with CarepathRx Careers, click on Sign In in the top right corner. Once you have created an account and are logged in, click on Job Alerts in top right corner and Create Job Alert! We hope you find a fulfilling career with CarepathRx!