Full-Time Tampa Accounts Receivables (AR) - Healthcare

Prosper Infusion; Tampa (FL); On-site; USD 45,000 - 65,000; Full time

Job summary

CommUnityCare is seeking a Pharmacy AR Specialist in Tampa to manage buy-and-bill AR, verify insurance, submit claims, and resolve billing discrepancies. The role requires collaboration with pharmacy teams, healthcare providers, and payers to streamline the revenue cycle and minimize denials.

The position focuses on claims tracking, reconciliation of payments, insurance verification, and ongoing process improvements to ensure timely reimbursement.

Qualifications

• High School diploma or equivalent; college degree preferred.
• Minimum 2 years medical or pharmacy billing experience.
• Experience with buy-and-bill processes.
• Strong knowledge of ICD-10, CPT, HCPCS coding.
• HIPAA compliance and documentation best practices.
• Proficient in EMR and billing software.

Responsibilities

• Track claims, ensuring timely processing and reimbursement.
• Reconcile payments and balances for buy-and-bill meds.
• Verify insurance coverage and maintain payer communications.
• Identify denials and take corrective actions.
• Suggest process improvements to reduce denials.

Skills

Medical terminology

ICD-10 CPT HCPCS coding

HIPAA compliance

Communication skills

EMR proficiency

AR follow-up

Education

High School Diploma

College degree preferred

Tools

Billing software

EMR systems

Payer portals

Job description

Full-Time Tampa Accounts Receivables (AR) - Healthcare

Pharmacy AR Specialist

The Pharmacy AR Specialist is responsible for managing the accounts receivable (AR) processes related to buy-and-bill medications. This includes verifying insurance coverage, submitting claims, resolving billing discrepancies, and ensuring timely reimbursement from payers. The role requires collaboration with pharmacy teams, healthcare providers, and insurance companies to streamline the revenue cycle and minimize denials.

Claims Management

• Track claims to ensure timely processing and reimbursement.
• Identify and address claim rejections and denials promptly.

Accounts Receivable Monitoring

• Reconcile payments and outstanding balances for buy-and-bill medications.
• Maintain detailed records of payer communications and payment status.
• Follow up on unpaid or underpaid claims.

Insurance Verification

• Compliance and Documentation:
• Ensure claims comply with payer policies, coding standards, and regulations.
• Maintain organized and accurate documentation for audit purposes.

Process Improvement

• Identify opportunities to optimize the buy-and-bill billing process.
• Implement solutions to enhance efficiency and reduce denials.

Knowledge, Skills and Abilities

• Advanced knowledge of medical terminology, ICD 10, CPT, HCPCS coding and HIPAA requirements.
• Ability to communicate effectively, both orally and in writing
• Demonstrated proficiency in the use of computer and commonly used software, including electronic medical records (EMR).
• Extensive knowledge and experience with commercial, government and state billing and reimbursement procedures.
• Proficiency in insurance verification, prior authorization, and AR follow-up.
• Attention to detail, organizational skills, customer service orientation, and analytical thinking.
• Through leadership and by example, ensures that services are provided in accordance with state and federal regulations,organizational policy, and accreditation/compliance requirements.
• Promptly identify issues and reports them to their direct supervisor.
• Maintain regular and predictable attendance.
• Acts in accordance with CommUnityCare’s mission and values, while serving as a role model for ethical behavior.

Qualifications

Minimum Education:

• High School Diploma or equivalent
• College degree preferred

Minimum Experience:

• 2 years medical billing, pharmacy billing, or revenue cycle management, particularly in buy-and-bill processes.