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Job Description
Job Id:
245
# of Openings:
0
Licenses/Certifications
✓Required: Registration/Certification with Board of Pharmacy as required by law
✓Desired: Certified Pharmacy Technician (PTCB)
ConnectMed360 is seeking a Medical Benefits/Billing Verification Specialist for our Patient Services office located in Louisville, KY. This position is a Full-Time position, Monday - Friday. We offer quarterly incentive bonuses with plenty of growth opportunities!
A career with us is more than just a job. It's an opportunity to connect and care for our patients, providers, communities and each other. We attract extraordinary people who have a strong desire to live our mission - to better the lives of those battling cancer and rare diseases. Compassion is more important than numbers. We value teamwork, respect, integrity, and passion.
We succeed when you do, and our company and management team work hard to foster an environment that provides you with opportunities for both professional and personal growth.
ConnectMed360 is a unique model creating customized patient support programs that connect manufacturers, providers, and patients to simplify the patient journey and deliver specialty medications and coordinated care quickly.
Salary is from $25 an hour and up, depending on experience.
We offer a variety of benefits including:
- Medical; Dental; Vision
- 401k with a match
- Paid Time Off and Paid Holidays
- Tuition Reimbursement
- Company paid benefits – life; and short and long-term disability
The Medical Benefits/Billing Verification Specialist is responsible for obtaining medical benefit verification and follow up with the beneficiary to obtain correct payor information.
Major Responsibilities for the Medical Benefits/Billing Verification Specialists include:
- Reimbursement experience for oncology or specialty injected/infused products in a buy and bill setting across all sites of care.
- Knowledge of payer landscape including state, federal, private third-party reimbursement issues, methodologies, and policies for physician administered products.
- Comprehensive understanding of Medicare Parts A, B, C, D, and knowledge of commercial insurance reimbursement.
- Knowledge of billing and coding for 1500/1450 claim forms.
- Clearly articulate complex reimbursement and billing information to HCPs, their office staff and/or patients to ensure understanding of coverage benefit and financial responsibility.
- Educate provider offices on local and regional payer coverage policies, issues, coding changes, and appropriate claims submission processes.
- Experience working with reimbursement call centers in support of patient access.
- Assist offices to understand payor denied or underpaid claims and provide education, as applicable for the office to resolve rejected, denied, or underpaid claims.
- Complete and accurate patient set up in our operating system.
- Perform full benefits verification on patients, including contacting payers to investigate and verify the terms and benefits of patient’s insurance policies as well as patient cost. Provide thorough, accurate and timely responses to requests from operation and/or patients regarding benefit information.
Other Qualifications for the Medical Benefits/Billing Verification Specialists include:
Education/Learning Experience
✓Required: HS diploma or GED.
✓Desired: Associates degree or equivalent program from a two-year college or technical school, or certificate program in pharmacy or healthcare.
Work Experience
✓Required: 2+ years of pharmacy technician experience
✓Desired: 2+ years of billing and coding experience; 6 months customer service experience, payer benefits experience (reimbursement, prior authorization, etc.), healthcare industry experience or healthcare related certification, license, or equivalent coursework is strongly preferred.
Skills/Knowledge
✓Required: Billing and coding knowledge. Current knowledge of all applicable local, state, and federal pharmacy laws, rules and regulations. Superior level of customer service and time management, as well as understanding the department operations.
✓Required: HS diploma or GED.
✓Desired: Associates degree or equivalent program from a two-year college or technical school, or certificate program in pharmacy or healthcare.
Work Experience
✓Required: 2+ years of pharmacy technician experience
✓Desired: 2+ years of billing and coding experience; 6 months customer service experience, payer benefits experience (reimbursement, prior authorization, etc.), healthcare industry experience or healthcare related certification, license, or equivalent coursework is strongly preferred.
Skills/Knowledge
✓Required: Billing and coding knowledge. Current knowledge of all applicable local, state, and federal pharmacy laws, rules and regulations. Superior level of customer service and time management, as well as understanding the department operations.
Licenses/Certifications
✓Required: Registration/Certification with Board of Pharmacy as required by law
✓Desired: Certified Pharmacy Technician (PTCB)
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