PBM Billing Specialist

CarepathRx, LLC; United States; On-site; USD 55,000 - 90,000; Full time

Job summary

CarepathRx is seeking a dedicated PBM Billing Specialist for its Revenue Cycle Team. In this role, you will manage the billing and collection of insurance claims, ensuring accuracy and timeliness. Ideal candidates are detail-oriented with previous experience in pharmacy benefit claims processing and possess strong communication skills.

Qualifications

• High school graduate or equivalent needed.
• One to three years of related prior work experience.
• Experience in medical field and administrative record management.

Responsibilities

• Process billing and collections of insurance claims.
• Ensure accuracy and timeliness of billing.
• Identify and recommend corrective actions for billing issues.

Skills

Communication

Problem-Solving

Attention to Detail

Self-Motivation

Organizational Skills

Knowledge of Insurance Policies

Mathematical Calculation

Education

High school diploma or GED equivalent

Tools

Microsoft Office

HCN 360

CPR+

Job description

Join to apply for the PBM Billing Specialist role at CarepathRx

Join to apply for the PBM Billing Specialist role at CarepathRx

We are seeking a dedicated PBM Billing Specialist for our Revenue Cycle Team. In this position you will be responsible for the billing and or collection of insurance claims.

Responsibilities

• Understand Third Party Billing
• Identify root cause of issues and demonstrate the ability to recommend corrective action steps to eliminate future occurrences of denials.
• Ensure the timeliness and accuracy of billing
• Meet quality assurance, benchmark standards and maintain productivity levels as defined by management.
• Processes patient and insurance changes
• Processes Home Infusion/Nursing claims
• Processes rejections for NCPDP emails to determine if the claim needs to be refiled or submitted for an appeal with the payer
• Able to identify billing trends
• Performs other duties as assigned

Skills & Abilities

• Must have experience processing pharmacy benefit claims
• Ability to communicate with patients, payors, outside agencies, and public through telephone, electronic and written correspondence.
• Effectively communicate in English; both oral and written, with physicians, location employees and patients to ensure questions and concerns are processed in a timely manner.
• Helpful, knowledgeable, and polite while maintaining a positive attitude
• Interpret a variety of instructions in a variety of communication mediums
• Knowledge of Home Infusion
• Knowledge of insurance policies and requirements
• Knowledge of medical billing practices and of billing reimbursement
• Maintain confidentiality and practice discretion and caution when handling sensitive information.
• Multi-task along with attention to detail
• Must be able to accurately perform simple mathematical calculations using addition, subtraction, multiplication, and division
• Self-motivation, organized, time-management and deductive problem-solving skills
• Work independently and as part of a team
• Collections or medical billing experience with basic understanding of ICD9, CPT4, HCPCS, and medical terminology is preferred.
• Familiarity with third party payor guidelines and reimbursement practices and available financial resources for payment of balances due is beneficial.
• Basic knowledge of Microsoft Office
• Knowledge of HCN 360 and/or CPR+ preferable

Qualifications

• High school graduate or equivalent. Excellent interpersonal, organizational, communication and effective problem-solving skills are necessary.
• High school diploma or GED equivalent
• One to three years of related prior work experience in a team-oriented environment
• Experience in medical field and administrative record management
• Background investigation (company-wide)
• Drug screen (when applicable for the position)
• Valid driver's license in state of residence with a clean driving record (when applicable for the position)

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Full-time

Job function

• Job function

  Other

• Industries

  Hospitals and Health Care

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