Collections Lead – Pharmacy Billing & Reimbursement

InfuCare Rx, Inc.; Fairfield, Northern (NJ, KY); Hybrid; USD 65,000 - 70,000; Full time

Job summary

InfuCare Rx in Fairfield, NJ is seeking a Collections Supervisor to lead the reimbursement process for pharmacy/infusion, interfacing with insurers and patients to secure accurate payments. You will train the collections team on CPR+ and billing processes, drive performance evaluations, and develop procedures to reduce DSO and improve cash flow.

A high school diploma is required; an associate or bachelor’s degree is preferred.

Qualifications

• Knowledge of Medicare/Medicaid guidelines for home infusion therapy.
• Infusion billing and collections for commercial and Medicaid payers.
• Working knowledge of infusion CPT, HCPCS and ICD-10 codes.
• Electronic claim filing.
• Medical Billing compliance proficiency.
• Strong knowledge of government insurance plans, managed care plans, HMO/PPOs, and patient billing.
• Accurate and detail-oriented including ability to work under pressure.
• Experience with Microsoft Office (Word/Excel).
• Communicates clearly and effectively in both oral and written communications.
• Proven problem-solving and critical thinking skills.
• Hands-on experience with a computerized billing system.
• Experience with CPR+ Infusion Pharmacy software for billing highly preferred.
• Ability to self-motivate and effectively solve complex problems through internal/external interaction.

Responsibilities

• Oversees and trains employees on the Collections Team.
• Ensure that new hires are fully trained on CPR+ and collection processes
• Assist in leading the staff in the development and improvement of their knowledge and skills
• Assists with performance evaluations.
• Prepare and submit clean claims to assigned insurance companies, either electronically or by paper.
• Follow up on all unpaid claims in a timely manner and prepare appeal or corrected claims to ensure payment.
• Review EOBs and act appropriately.
• Timely Receivables-Revenue Management and reporting.
• Prepare daily reporting for distribution to staff.
• Develop and implement new processes and procedures to help reduce DSO.
• Submit write off requests, identify bad debt as necessary.
• Identify all roadblocks which potentially could delay claims payment and be ready to discuss solutions with management.
• Bill payor plus patient responsibility amounts accurately and in a timely manner.
• Handle phone interaction with patients and insurance companies regarding billing and statement questions.
• Interpret contracts/maintain Payor customer service relationships in order to produce accurate claims, validate reimbursement, and keep A/R to company standards.
• Assist with PBM and Medical Claim Audits – (both pre and post submission).
• Ensure that new hires are fully trained in CPR+ and collection processes.
• Performs other related duties as assigned.

Skills

Medicare/Medicaid

Infusion billing

CPT/HCPCS/ICD-10

Electronic claim filing

Billing compliance

Insurance plans

Attention to detail

MS Office

Communication

Problem solving

CPR+ software experience

Self-motivation

Education

HS Diploma

AA/BA preferred

Job description

InfuCare Rx in Fairfield, NJ is seeking a Collections Supervisor to lead the reimbursement process for pharmacy/infusion, interfacing with insurers and patients to secure accurate payments. You will train the collections team on CPR+ and billing processes, drive performance evaluations, and develop procedures to reduce DSO and improve cash flow.

A high school diploma is required; an associate or bachelor’s degree is preferred.