REIMBURSEMENT SPECIALIST - Remote
Soleo Health is seeking a Reimbursement Specialist to work from home who can effectively perform the billing and collection activities necessary to facilitate the reimbursement process.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Responsible for the preparation of accurate medical and pharmacy claims for home infusion therapy services to various payers (e.g. commercial Rx Card Payers, Government Payers, Employer/ Institutional Payers, and Medical).
- Creates and submits secondary medical claims in a timely manner;
- Monitors billing requirements pursuant to contracts with third party payers or government programs.
- Reviews payments/EOBs applied to invoice to ensure that correct payment has been received;
- Addresses payer and electronic transmission rejections;
- Researches claim denials and follows-up with payer for resolution;
- Monitors payer correspondence and provides requested information, as appropriate;
- Makes routine collection calls on outstanding claims;
- Researches refund requests received by payers and prepares refund according to findings;
- Documents notes in a clear and concise fashion in Company software system;
- Identifies issues/trends and escalates to Manager when assistance is needed;
- Provides exceptional Customer service to internal and external customers;
- Ensures compliance with federal, state, and local governments, third party contracts, and company policies.
QUALIFICATION REQUIREMENTS
- Knowledge of home infusion therapy billing practices, preferred;
- Knowledge of HCPC coding and medical terminology;
- Excellent math and writing skills
- Experience providing customer service to internal and external customers
- CPR+ systems experience preferred
- Excel and Outlook experience required;
- High School Diploma or GED required;
