Billing Specialist

Maxor National Pharmacy Services, LLC; United States; Remote; USD 40,000 - 60,000; Full time

Job summary

An established industry player is seeking a detail-oriented Billing Specialist to join their remote team. In this role, you will be responsible for preparing and submitting clean claims to various insurance providers, ensuring compliance with billing requirements, and maintaining accurate patient records. This position offers the chance to work in a supportive and collaborative environment, where your contributions will directly impact the efficiency of billing processes. If you thrive in a fast-paced setting and have a knack for organization and communication, this opportunity could be the perfect fit for you.

Benefits

Comprehensive mental health resources

Nationwide Blue Cross Blue Shield PPO

Company paid life/AD&D insurance

Short-term and long-term disability insurance

Employer-matched 401k Plan

Industry leading PTO plan

Collaborative team-oriented environment

Work from home model

Flexible dress code

Qualifications

• 1-2 years of relevant experience in billing or related fields.
• Strong knowledge of Microsoft Office and data entry skills.

Responsibilities

• Prepare and submit clean claims to insurance carriers and Medicare.
• Process denied claims and communicate with staff for accurate billing.

Skills

Data Entry

Microsoft Office

Organizational Skills

Communication Skills

Problem Solving

Ability to Multi-task

Education

High School Diploma or Equivalency

Tools

Microsoft Outlook

Job description

Overview

Continued growth at Maxor has created an opportunity for a Billing Specialist. The Billing Specialist is responsible for preparation and submission of clean claims to third party insurance carriers, Medicare, Medicaid, copay assistance programs and foundations either electronically or by hard copy billing. This includes primary, secondary, and tertiary claims.

Position Location

This is a remote-based position within the Continental US.

Responsibilities

ESSENTIAL FUNCTIONS (These duties must be performed with or without reasonable accommodation. This document in no way states or implies that these are the only duties to be performed by the employee occupying this position):

1. Prepare and submit clean claims to third party insurance carriers, Medicare, Medicaid, copay assistance programs and foundations either electronically or by hard copy billing. This includes primary, secondary, and tertiary claims.
2. Assist in billing some secondary NCPDP/RX claims including claims secondary to Medicare.
3. Assist in making adjustments on accounts receivable collections and maintaining the patient financial record including adjustments due to secondary NCPDP/RX claims.
4. Submit PA request to Texas Medicaid & their managed care plans for supplies.
5. Appeal Medicare and Texas Medicaid claims when necessary and follow-up until complete.
6. Process denied/rejected claims by correcting any billing error and resubmitting claims to third party insurance carriers.
7. Communicate with Pharmacists and other staff to ensure that all necessary information is in place prior to filing claims.
8. Perform Medicare and Texas Medicaid eligibility checks.
9. Responsible for calculating Medicare pricing for new referrals, as well as patient responsibility for refills.
10. Responsible for ensuring Medicare patients meet criteria and we have everything Medicare requires prior to approving an initial dispense and refills. This includes requesting medical documentation when necessary.
11. Responsible for working various daily, weekly, and monthly reports related to billing functions.
12. Maintain a good working knowledge of all payer and provider contracts.
13. Report financial information to the Director of Reimbursement Services and other appropriate management as needed.
14. Keep updated on all third party billing requirements and changes for insurance types within their area of responsibility.
15. Demonstrate knowledge of and support policies and procedures, operating instructions confidentiality standards, and the code of ethical behavior.
16. Meet performance standards and expectations.
17. Follow all Company policies and procedures.
18. Assist with projects as necessary.
19. Assist other areas as needed.
20. Assist in compiling necessary reports and/or audit information as requested.
21. Work cooperatively with other staff members to promote a positive and team-oriented work environment.
22. Participate in the Performance Improvement/Quality Management/and Adverse Event/Product Complaint Processes.
23. Maintain accurate and complete patient records.
24. Participate in pharmacy orientation programs, training programs, pharmacy, Specialty monthly meeting, in-services, and other programs as required.
25. Exemplify excellence in customer communications and service.
26. Have a good understanding and working knowledge of all Maxor policies and procedures, accreditation requirements and HIPAA operational guidelines.
27. Must be able to cope with the mental and emotional stress of the position and duties.
28. Promptly report any allegations of impropriety to the Compliance Department.
29. Comply with Maxor’s Ethical Business Conduct policy and Maxor’s Compliance Program.
30. Remain free from exclusion under the OIG and SAMS Medicare/Medicaid lists.
31. Complete required training, as assigned, within the established timeframes.
32. Maintain regular attendance in accordance with established policies.
33. Perform other job-related duties as assigned.

Qualifications

Education:

• High School Diploma or Equivalency

Experience:

• One-Two years relevant experience; any combination of the necessary knowledge, skills, and abilities.

Knowledge, Skills, and Abilities:

• Working knowledge of computer software, specifically Microsoft Office and Outlook
• Ability to accurately enter data into a computer system
• Ability to prioritize work to meet deadlines
• Ability to multi-task and work accurately under pressure
• Ability to work through and solve problems independently
• Positive attitude, innovative, self-starter
• Excellent organizational and communication skills, both written and verbal

WE OFFER:

A diverse, progressive culture that supports a work from home model, a “dress for your day” attire when working onsite, and a collaborative, team-oriented environment. Our industry leading compensation and health benefits include:

• Comprehensive mental health and wellbeing resources
• Nationwide Blue Cross Blue Shield PPO with employee friendly plan design, including $850 individual annual medical deductible, $25 office visit copays, Low biweekly premiums
• Company paid basic life/AD&D, Short-term and Long-term disability insurance
• Rx, dental, vision, short-term disability, and FSA
• Employer-matched 401k Plan
• Industry leading PTO plan
• And MORE!