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Reimbursement Specialist

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  • Full-Time
  • Ged/High School Diploma
  • 3+ Yrs
  • Temecula
  • Wildomar, CA
  • $20.00-$24.00 hr.

Remote position within 1 hour of Temecula, CA. Will be interacting with private, state, & federal payer representatives, fiscal intermediaries, case managers, pharmacy partners, & company’s field personnel in role of coordinating reimbursement from product dispensing through to completion & final resolution of payment cycle. Duties include: Supporting all reimbursement activities related to revenue base representing approx. $200 million per year & projected DSO of less than 40 days; Submitting &/or following up on payer claims (may include primary, secondary, tertiary claims, &/or patient statements); Verifying accuracy of payments according to payer’s fee schedule; Possessing basic understanding & ability to audit accounts receivables (including analysis of payments, contractual discounts &/or adjustments, bad debt, recoupments, refunds, & credit/debit function); Drafting professional, concise cover letters, appeals, & correspondence (may include provider dispute forms, re-openings, reconsiderations, & various levels of appeals as necessary during collection process); Performing resolutions of credit balances (may include revenue adjustments, balance transfers, recoupments, &/or refunds); Clearly & accurately documenting all collection efforts within AR system; Completing & submitting monthly claim status reports; Promptly informing management of reimbursement rates, changes, &/or issues which may directly affect company’s receivables; Maintaining reimbursement records in compliance with company’s policies & procedures; Attending & participating in departmental meetings; Continuously striving to improve processes & service quality to internal & external customers; Attending pertinent job-related trainings & educational seminars; Complying with policies & procedures stated in Injury & Illness Prevention Program by always working in safe manner & immediately reporting any injury, safety hazard, or program violation; Ensuring conduct is consistent with all Compliance Program Policies & procedures when engaging in any activity on behalf of company; Immediately reporting to management any concerns or violations; Displaying dedication to position responsibilities & achieving assigned goals & objectives; Displaying enthusiasm & dedication to learning how to be more effective on job & share knowledge with others; Working effectively with coworkers, internal & external customers, & others by sharing ideas in constructive & positive manner; Listening to & objectively considering ideas & suggestions from others; Keeping commitments; Keeping others informed of work progress, timetables, & issues; Addressing problems & issues constructively to find mutually acceptable & practical business solutions; Addressing others by name, title, or other respectful identifier, & respecting diversity of work force in actions, words, & deeds; Conducting special projects as requested by management; Performing other duties as assigned by management. Required qualifications: High school diploma/equivalent; 3 yrs healthcare related exp. (i.e. DME, home care, medical insurance, or medical case management); Basic knowledge of reimbursement principles as well as structure of various private, federal, & state payer entities & specific program issues related to each; Basic knowledge of medical reimbursement principles; Intermediate to advanced MS Office skills; Basic to intermediate understanding of Internet technologies, including payer portals; Excellent verbal & written communication skills along with ability to interact effectively with customers, coworkers, & all levels of management; Ability to effectively communicate with all levels of personnel within payer realm, including proficiency in accessing appropriate personnel to resolve problem claims; Ability to make independent judgments & work with minimal supervision; Strong organizational skills & detail-oriented with ability to manage multiple assignments & responsibilities; Ability to prioritize work, work effectively, & maintain expected productivity; Ability to exercise discretion & maintain confidentiality to level of required HIPAA standards; Represent company in professional manner & appearance at all times. Pharmacy or home infusion exp. preferred. Mon-Fri/8:00am-5:00pm. Full-time position. Wage: $20.00-$24.00 hr. (#4.0319.119 – Wildomar)