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Form of workJob Summary:
Job Summary:
Perform duties to process referrals, focusing on accuracy, timeliness, and adherence to processes to reduce denial rate, DSO, and bad debt. Recognize additional revenue opportunities and improve collection rates while working within standard or accepted practice limits. Credentialing/re-credentialing and Contract applications.
Duties/Responsibilities:
- Review patient files for completeness and accuracy, identify and audit claims, ensure all revenue opportunities are included, and complete and submit primary and secondary billing to payers for reimbursement via paper bills and clearinghouse submittals.
- Communicate effectively with franchise partners and other VCI departments regarding the status of order intake.
- Document case activity, communications, and correspondence in the computer system to ensure completeness and accuracy of account activity and actions taken to resolve outstanding claims issues. Schedule follow-ups in required intervals.
- Investigate and verify benefits for pharmacy and medical third-party claims.
- Obtain prior authorizations; initiate requests, follow up to provide the additional required information, track progress, expedite responses from insurance carriers and other payers, and
- maintain contact with customers to keep them continuously informed.
- Track, report, and escalate service issues arising from requests for authorizations or other issues that delay service to ensure patient access and to avoid delays that may interrupt therapy.
- Communicate financial obligation information with patients so that they clearly understand all therapy costs before starting service.
- Contribute medical billing expertise to the design of training and knowledge transfer programs, materials, policies, and procedures to improve the efficiency and effectiveness of the RCM team. Assist with processing online adjudication of collection issues and nurse billing as assigned.
- Perform other related duties as assigned.
Required Skills/Abilities:
- Excellent communication skills: listening, speaking, understanding, and writing English while influencing patients, caregivers, and payer representatives, answering questions, and advancing reimbursement and collection efforts.
- Proven understanding of processes, systems, and techniques to ensure successful billing and collection working with all payer types.
- Proven ability to identify gaps and problems from a documentation review, determine lasting solutions, make effective decisions, and take necessary corrective action.
- Strong organizational skills with the ability to track and maintain clear, complete records of activities, cases, and related documentation.
- Proven knowledge and skill in utilizing MS Office suite of software and pharmacy applications.
Education and Experience:
- High School Diploma or equivalent and additional specialized training in intake, pharmacy/medical billing, and/or collections.
- Two years’ Intake, Medical Billing, and/or Collections experience required.
- Two years of home infusion therapy is required.
- Coding Course Certification is highly preferred.
