Enrollment/Billing Representative

Collections Specialist Job Description 

About CarepathRx 

CarepathRx is transforming pharmacy care delivery for health systems and hospitals, delivering improved patient outcomes that drive clinical, quality, and financial results. Through the industry’s most comprehensive, end-to-end hospital pharmacy care delivery model, CarepathRx is turning hospital pharmacy into an active care management strategy and revenue generator while providing support across the patient’s complete healthcare journey. The company takes an enterprise approach, providing a powerful combination of technology, market-leading clinical pharmacy services, and wrap-around services that optimize pharmacy performance across the enterprise for fully integrated pharmacy operations, expanded healthcare services, improved ambulatory access, minimized clinical variation and new health system revenue streams. Today, CarepathRx serves more than 15 health systems and 600 hospitals, with more than 1,500 employees nationwide.  

CarepathRx offers a competitive salary and comprehensive benefit plan. For more information, please visit http://carepathrxllc.com/ 

Summary 
We are seeking a dedicated Medical Collections Specialist for our Revenue Cycle Team. In this position you will be responsible for the collections of insurance claims. 
 
Essential Duties and Responsibilities 
 

• Understand Third Party Billing and Collection Guidelines. 

• Identify root cause of issues and demonstrate the ability to recommend corrective action steps to eliminate future occurrences of denials. 

• Meet quality assurance, benchmark standards and maintain productivity levels as defined by management. 

• Contacts payer, or patient as appropriate 

• Documents all collections activity in patient collections notes 

• Documents work performed/action taken on AR Aging Report and/or Over/Under Report 

• Process all Payer appeal requests within the time frame required by the Payer 

• Processes all approved adjustments 

• Processes rejections and denials to determine if the claim needs to be refiled or submitted for an appeal with the payer 

• Reviews patient information in appropriate system to determine why the claim is unpaid, if an adjustment is valid and whether additional approval is required 

• Able to identify errors, correct claims and reprocess for reimbursement 

• Able to read and interpret an EOB for accurate understanding of denial 

• Knows how to investigate claims, contracts for reimbursement 

• Performs other duties as assigned 

 
QUALIFICATIONS 
Employment is contingent on 

• 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) 

Education and/or Experience 

• 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 

• Strong customer service background 

Skills, Knowledge, and Abilities 
 

• 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. 

• Medicare knowledge of billing requirements specific to DMEMAC 

HCN360 and CPR+ knowledge preferred. 

CarepathRx provides equal employment opportunity to all qualified applicants regardless of race, color, religion, national origin, sex, sexual orientation, gender identity, age, disability, genetic information, or veteran status, or other legally protected classification in the state in which a person is seeking employment. Applicants are encouraged to confidentially self-identify when applying. Local applicants are encouraged to apply. Drug-free work environment. Must be eligible to work in this country.