Reimbursement Specialist

PromptCare, Inc.; New Providence (NJ); Hybrid; USD 52,000 - 70,000; Full time

Benefits offered by this job

Comprehensive Medical, Dental, and Vis

401(k) Plan with Company Match

Generous PTO: Vacation, Sick Time, etc

Life Insurance: Standard coverage

Employee Assistance Program

Well-being resources

Disability insurance

Commuter spending programs

Employee referral bonuses

Job summary

PromptCare is seeking a Reimbursement Specialist to manage all patient billing and collections in a fast-paced home infusion environment. The role requires proficiency in insurance data collection, verification, authorization, and adherence to company policies.

Hybrid schedule: 2 days in the office in New Providence, NJ and 3 days remote. The successful candidate will handle revenue cycle tasks, denials management, and proactive issue resolution while maintaining confidentiality and

Qualifications

• High School Diploma or equivalent.
• 2-3 years of experience in electronic claims submission and medical collections preferred.
• Working knowledge of insurance plans including Medicare and Medicaid required.
• Industry experience with billing/collections in DME, home infusion and/or enteral preferred.
• Accounts receivable and accounting experience preferred.
• Knowledge of CPR+ and Caretend software preferred.

Responsibilities

• Collections of third-party payor accounts for assigned payers.
• Ensure proper follow-up on all revenue cycle aspects related to reimbursement.
• Maintain and update shared documentation for policies, rules and limitations.
• Identify adjustments, payment trends and denials and escalate issues.
• Maintain confidentiality in patient care and office activities.
• Collaborate with Intake & Reauthorization Specialist to ensure timely collections.
• Assist PBM and Billing Specialist with issues, backlogs and month-end processes.
• Field and troubleshoot calls from patients regarding benefits and balances.
• Proactively seek resolutions to billing issues as they arise.
• Perform CPR+/Caretend transactions accurately and timely.
• Perform other duties as assigned.

Skills

Electronic claims submission

Medical collections

Revenue cycle knowledge

Education

High School Diploma

Tools

CPR+

Caretend

Job description

Description

PromptCare is seeking a highly motivated, experienced and detail-oriented Reimbursement Specialist to join our team. The ideal candidate will have experience in infusion reimbursement and be able to work in a fast-paced environment. The Specialist will be responsible for all patient billing and collections and must be proficient in all phases of insurance data collection, verification, and authorization. Documentation and computer input of the new referral and subsequent patient admission from start to finish is critical and must always follow PromptCare’s policies and procedures. If you are a detail-oriented individual with a passion for healthcare billing and collections, we encourage you to apply for this exciting opportunity in the Homecare Infusion industry. To learn more about our company and services, please visit us at PromptCare In-home Respiratory and Infusion

Reporting to:

Departmental Lead, Supervisor or Manager

Job Type:

Non-Exempt, Full-time, 40 hours per week, Monday-Friday

Location:

Hybrid out of New Providence, NJ (2 days in the office and 3 days working from home)

Requirements

• High School Diploma or equivalent
• 2-3 years of experience in electronic claims submission and medical collections preferred
• Working knowledge of insurance plans including Medicare and Medicaid required
• Industry experience with billing/collections in DME, home infusion and/or enteral preferred
• Accounts receivable and accounting experience preferred
• Knowledge of CPR+ and/or Caretend software preferred

Job Responsibilities, included but not limited to:

• Collections of third-party payor accounts for assigned payers
• Ensure proper follow-up is performed on all aspects of the revenue cycle related to reimbursement, including projects, problem and issues escalation, denials management and research
• Maintain and update shared documentation to assist Intake Team with the various policies, rules and limitations for insurance plans
• Identify adjustments, payment trends and denials and ensure problems are escalated as necessary
• Maintain confidentiality in all aspects of patient care, employee activities and office environment
• Communicate changes regularly or as often as needed
• Work collaboratively with other department staff such as Intake & Reauthorization Specialist to ensure timely collections
• Assist the PBM and Billing Specialist with issues, billing backlogs and end-of-month processes
• Field and troubleshoot calls from patients regarding benefit, claims and patient balances
• Pro-actively seek resolutions to any billing issues that may arise
• Perform CPR+/Caretend related transactions accurately and timely
• Perform other duties as assigned

Physical Demands

The physical requirements listed here indicate what an employee must meet to effectively perform this role's essential functions. The employee frequently needs to communicate verbally, listen attentively, and spend prolonged periods sitting at a desk and working on a computer. The role also requires lifting files, opening filing cabinets, and bending or standing as needed.

Benefits & Perks

• Comprehensive Medical, Dental, and Vision Package
• 401(k) Plan with Company Match
• Generous PTO: Vacation, Sick Time, Personal Days, and Paid Holidays
• Life Insurance: Standard coverage with optional enhancements
• Employee Assistance Program: Free counseling and coaching sessions
• Emotional Well-being and Work-Life Balance Resources
• Short & Long-Term Disability: Company-paid with optional supplements
• Accidental Death and Dismemberment Insurance
• FSA and HSA: Manage healthcare expenses
• Commuter Spending Programs
• Volunteer and Engagement Opportunities
• Employee Referral Bonuses
• Exclusive Discounts on entertainment, travel and various other supplemental and cellphone plans

Equal Employment Opportunity

The PromptCare Companies is committed to Equal Employment Opportunity (EEO) and prohibits employment discrimination on the basis of race, color, age, national origin, religion, gender, gender identity, sexual orientation, pregnancy, marital status, genetic disposition, disability, veteran's status or any other characteristic or classification protected by State/Federal/Local laws. We foster a work environment in which diversity and inclusion are embraced, people are hired and advanced on their merits, and employees are treated with mutual respect and dignity.