Billing Specialist

About This Role

The Billing Specialist is responsible for accurately and timely processing customer bills and insurance claims, assisting with daily and month-end billing functions, procedures, and reporting. This role provides excellent customer service to patients, caregivers, medical providers, and insurance carriers.

Responsibilities

• Research and establish patient eligibility coverage with insurance providers, including private individuals and/or government entities
• Reverify benefit coverage criteria as needed for claims follow-up
• Accurately enter and/or update patient/insurance information into the billing system
• Maintain and continually audit patient files and corresponding documentation necessary to defend third-party audits and ensure payer and company compliance
• Accurately enter patient information into the pharmacy system
• Provide assistance and timely response to all billing customer inquiries via phone or electronic communications
• Research and resolve patient billing issues regarding insurance eligibility, coverage, and related benefits
• Provide guidance and support to resident or responsible party by running Medicare plan comparisons during open enrollment and special enrollment periods
• Proactively review patient profiles, drug regimens, and insurance coverage to evaluate options to save resident money
• Complete daily census, admit, discharge, and room changes for the facilities assigned
• Process patient payments, returns, and credits
• Transmit individual credit card payments as needed
• Pursue payment from delinquent accounts and make payment arrangements
• Research, identify, and organize requested audit documentation in a timely manner
• Perform prescription claims adjudication, including communication with insurance companies regarding rejected claims, eligibility, prior authorizations, or other issues as needed
• Make corrections as needed and rebill claims as necessary
• Develop knowledge and understanding of pharmacy facility billing requirements (Medicare, Medicaid, Prescription Drug Plans (PDPs), and Third-Party Insurances)
• Develop proficiency in the utilization of billing systems

Requirements

• Work Ethic/Integrity – must possess intrinsic drive to excel coupled with values in line with company philosophy
• Relational – ability to build relationships with business unit management and become a “trusted advisor”
• Strategy and Planning – ability to think ahead, plan, and manage time efficiently
• Problem Solving – ability to analyze causes and solve problems at a functional level
• Team Oriented – ability to work effectively and collaboratively with all team members