Job Description

JOB PURPOSE

The representative is responsible for collections, account follow up, billing allowance posting for the accounts assigned to them

DUTIES AND RESPONSIBILITIES

• Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites

• Meets and maintains daily productivity standards established in departmental policies

• Meets and maintains quality standards established in departmental policies

• Uses the MPower workflow system, client host systems and other tools available to them to collect payments and resolve accounts

• Adheres to the policies and procedures established for the client/team

• Working knowledge of the insurance follow-up process with understanding of the fundamental concepts in healthcare reimbursement methodologies

• Perform special projects and other duties as needed.   Assists with special projects by utilizing excel spreadsheets, and the ability to communicate results

• Identify and report underpayments and denial trends

• Initiate appeals when necessary

• Basic knowledge of healthcare claims processing including: ICD-9/10, CPT, HCPC codes as well as 1500 forms

• Ability to analyze, identify and resolve issues causing payer payment delays

• Act cooperatively and courteously with patients, visitors, co-workers, management and clients

• Maintain confidentiality at all times

• Maintain a professional attitude

• Other duties as assigned by the management team

• Use, protect and disclose patients protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.  Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

QUALIFICATIONS

• 3+ years’ experience in Home Infusion and/or Specialty Pharmacy insurance collections, including submitting and following up on claims of medical billing work experience

• Previous experience in Home Infusion and/or Specialty Pharmacy billing required

• Knowledge of CPT and ICD-9/10–CM coding

• Ability to work well individually and in a team environment

• Proficiency with MS Office

• Strong oral/written communication skills

• Strong organizational skills

• Strong Math skills

• High School Diploma

• Medical Billing and Coding certification preferred, but not required

Med-Metrix and/or Medi-Centrix will not discriminate against any employee or applicant for employment because of race, creed, color, sex (including pregnancy), religion, national origin, military status, sexual orientation gender identity, expunged juvenile records, conviction or arrest record, age, disability, genetic disposition or carrier status, domestic violence victim status, or marital status, military status, atypical hereditary cellular or blood trait, disabled veterans, veterans of the Vietnam era, disability (including aids and HIV related illnesses) and any other characteristic protected by federal, state or local law.

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