Billing Specialist

Soleo Health Inc; United States; Remote; USD 52,000 - 72,000; Full time

Benefits offered by this job

401(k) with a Match

Paid Time Off

Annual Merit Based Increases

Education Assistance Program

Company Paid Disability and Basic Life

HSA and FSA Options

Paid Parental Leave Options

Affordable Medical, Dental, and Vision

Job summary

Soleo Health is seeking a Billing Specialist to support our Specialty Infusion Pharmacy and work Remotely (USA). The Billing Specialist will handle insurance and self-pay billing, excluding Medicare, and submit claims.

This role requires 2 years of home infusion billing experience and strong attention to payer rules and timelines. Join Soleo Health to contribute to accurate billing, timely reimbursements, and compliant processes across payer types while enjoying supportive benefits and a

Qualifications

• 2 years of home infusion billing experience required.
• High School Diploma or equivalent.
• Knowledge of HCPCS coding and medical terminology.
• Excellent phone and email communication skills.

Responsibilities

• Prepare accurate medical claims for various payers.
• Review claims pricing discrepancies and update fee schedules.
• Submit secondary electronic pharmacy and medical claims.
• Bill manufacturer copays and manage portal entries.
• Follow up with payers on rejections and denials.
• Ensure claims are billed with correct CPT/ICD codes.
• Coordinate with pharmacy team to resolve PBM issues.
• Maintain patient accounts with detailed notes.
• Provide exceptional customer service to internal/external customers.
• Adhere to federal, state, local regulations and contracts.

Skills

Billing experience

Customer service

Communication skills

Computer literacy

ICD10/CPT knowledge

Education

High School Diploma or equivalent

Tools

HCPCS coding systems

Medical terminology resources

Job description

Soleo Health is seeking a Billing Specialist to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care! 2 years of home infusion billing experience is required.

• Competitive Wages
• 401(k) with a Match
• Referral Bonus
• Paid Time Off
• Great Company Culture
• Annual Merit Based Increases
• Paid Parental Leave Options
• Affordable Medical, Dental, and Vision Insurance Plans
• Company Paid Disability and Basic Life Insurance
• HSA and FSA (including dependent care) Options
• Education Assistance Program

The Position:

The Billing Specialist will primarily be responsible for insurance and self-pay billing, excluding Medicare. This role is also responsible for submitting electronic and paper claims. Follows up with clearing house vendors on accepted and working rejections.

Responsibilities include:

• Preparation of accurate medical claims based on contracted agreements for services to various payers (e.g. Commercial Payers, Government Payers, Employer/ Institutional Payers).
• Reviewing and identifying claims pricing discrepancies based on updates/changes to fee schedules.
• Creates and submits secondary electronic pharmacy and medical claims in a timely manner.
• Billing of manufacturer copays, which includes entering the necessary information into portal or billing via paper at time of initial billing.
• Monitors billing requirements pursuant to contracts with third party payers or government programs.
• Answer insurance/billing questions from branch staff and help educate.
• Review information from electronic medical records in patient account (IE: auth, benefit verification, orders, accounts receivable, etc.) to ensure preparation and submission of clean claims.
• Perform routine revenue review of claims billed within the current month.
• Answering incoming calls and triage if necessary.
• Create claim batches and process them via electronic submission.
• Manually process any claims that are not eligible for electronic billing. Identify any claims that need attention, make corrections, and resubmit.
• Ensure coding to the highest level of specificity and for maximum reimbursement by third party payers.
• Daily review and follow up of unbilled delivery tickets in billing review and ready to bill queues.
• Accurately notate patient accounts to reflect all actions made including marginal, split claim notes, missing COGS, etc.
• Coordinates with the pharmacy team daily to ensure any PBM issues are addressed and resolved, accepted into revenue and billed timely
• Effectively utilize time and resources to meet performance goals.
• Provides exceptional Customer service to internal and external customers.
• Ensures compliance with federal, state, and local governments, third party contracts, and company policies.
• Clearly communicate any billing related issues to all appropriate parties including: Intake, collections, RBL, and manager.
• Monitoring the unbilled-pending invoices queues and communicate to the branch on missing or needed documents or information.
• Maintain current knowledge of departmental and organizational policies.

Schedule:

• Monday - Friday, 8:30am - 5pm

Requirements

• 2 years of home infusion billing experience is required
• High School Diploma or equivalent
• Knowledge of HCPC coding and medical terminology
• Experience providing customer service to internal and external customers
• Must be computer literate
• Must be dependable. Excellent phone and email communication skills.
• Working knowledge of ICD10, CPT, NCCI; must be familiar with modifier application and standard billing regulations

About Us:

Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services, administered in the home or at alternate sites of care. Our goal is to attract and retain the best and brightest as our employees are our greatest asset. Experience the Soleo Health Difference!

Soleo’s Core Values:

• Improve patients’ lives every day
• Be passionate in everything you do
• Encourage unlimited ideas and creative thinking
• Make decisions as if you own the company
• Do the right thing
• Have fun!

Soleo Health is committed to diversity, equity, and inclusion. We recognize that establishing and maintaining a diverse, equitable, and inclusive workplace is the foundation of business success and innovation. We are dedicated to hiring diverse talent and to ensuring that everyone is treated with respect and provided an equal opportunity to thrive. Our commitment to these values is evidenced by our diverse executive team, policies, and workplace culture.

Soleo Health is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for all employees. Soleo Health does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non-merit factor.

Keywords:billing representative, accounts receivable, collections, claims, medical coding and billing