Reimbursement Associate 163057

Preferred Homecare Phoenix , AZ 85002

Posted 3 weeks ago

The Reimbursement Associate performs accounts receivable functions including qualification of appropriate documentation and billing. Helps ensures compliance with all government, contract, and company policies and regulations.

Essential Duties and Responsibilities include the following.

  • Checks and understand eligibility and verification requirements

  • Reviews claims using basic understanding of insurance coverage and criteria to help determine appropriate steps to submit payable claim

  • Researches overdue accounts and follows up by mail and/or phone to insurance carriers or customers on delinquent payments

  • Reviews denied or unpaid claims to determine proper resolution

  • Resubmits general claims with proper documentation for further carrier review

  • Responds to inquiries regarding account status in a timely manner

  • Understands billing software in order to review customer information and enter data

  • Maintains notes and documents progress appropriately and timely

  • Brings recurring issues to the attention of management

  • Performs other duties as assigned

Qualifications:To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience: High school diploma or GED equivalency. Prefer 3-6 months home health, customer service, call center, insurance, or reimbursement experience. Strong interpersonal, communication, and organizational skills required.

Computer Skills:To perform this job successfully, an individual should have basic computer and typing skills.

Physical Demands:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

The employee must occasionally lift and/or move up to 10 pounds. The employee is frequently required to sit; use hands to fingers, handle, and feel; and talk and hear. The employee is occasionally required to stand and walk.

icon no score

See how you match
to the job

Find your dream job anywhere
with the LiveCareer app.
Mobile App Icon
Download the
LiveCareer app and find
your dream job anywhere
App Store Icon Google Play Icon
lc_ad

Boost your job search productivity with our
free Chrome Extension!

lc_apply_tool GET EXTENSION

Similar Jobs

Want to see jobs matched to your resume? Upload One Now! Remove
Field Reimbursement Manager

Syneos Health, Inc

Posted Yesterday

VIEW JOBS 2/24/2021 12:00:00 AM 2021-05-25T00:00 Overview You're an expert facilitator: you open doors, foster communication and bridge the gap. Connecting people with the information they need is your forte. You're a unifier by nature and you're at your best when setting others up for success. Your ability to clear the way, extrapolate intricate details, attend to complex situations and serve as a trusted go-between make you a perfect fit for a Field Reimbursement Manager role at Syneos Health. Responsibilities The Field Reimbursement Manager (FRM) will operate as the subject-matter expert on reimbursement, access, and coverage issues affecting the clients products. Educate HCPs and their staff on matters related to reimbursement, access and coverage to facilitate appropriate patient access. The FRM will analyze reimbursement and access issues and act as the local access and reimbursement resource for other field sales force personnel and region management. Coordinate with the Hub concerning individual patient cases including patient reimbursement assistance, referrals to enrollment, and overall coordination. The FRM will need to collaborate cross functionally with Field Sales, Marketing, Market Access, Public Affairs, State & Government Affairs, Trade, and Specialty Pharmacy Accounts while abiding by all corporate and industry policy and procedures. You will: * Analyze reimbursement issues and opportunities * Provide offices product reimbursement expertise * Provide reimbursement education to field teams etc. * Coordinate on reimbursement issues with third parties including Hubs * Liaising with Specialty Pharmacy for pharmacy benefit products * Educate HCPs on reimbursement processes claims submissions, procedures and coding requirements of payer organizations (local payers, government payers, etc.) * Provide information to HCP on how the products are covered under the benefit design (Commercial, Medicare Part D, Medicaid) * Answer questions about coverage, ICD-10 codes of product, including patient-specific access questions * Educate and update HCPs on key private and public payer coverage and changes that impact the products access for patients * Support patient access to the products by providing subject matter expertise on reimbursement issues that may be barriers to product access in a manner that complies with policies, processes, and standard operating procedures * Educate HCPs and their practice personnel on the products Hub program including reimbursement, financial assistance and Hub tools (e.g. provider portal tool, copay tracking, forms) * Demonstrate knowledge of and communicate information about resources and forms available for access and reimbursement * Track and report on access and barriers to patient access within territory * Liaise with Hub regarding reimbursement and financial assistance programs and assist HUB hotline staff in addressing case, coverage, or reimbursement resolutions * Verification, pre-authorization, billing, coding, claims, and appeals/grievances); Medicare and Medicaid rules and regulations Job Requirements Along with demonstrated initiative, resourcefulness and a results-oriented mindset, the ideal candidate has: * BS/BA Degree required * 5+ years in Commercial Biotech/Pharmaceutical experience * 2+ years field reimbursement experience preferably with specialty products * Proven experience with Hubs, in-depth knowledge on issues related to billing, coding, appeals across physician types * Experience with commercial payers, Medicare plans and state Medicaid in geographic region * Exhibit competent understanding of Hub activities At Syneos Health, we believe in providing an environment and culture in which our people can thrive, develop and advance. We reward and recognize our people by providing valuable benefits and a quality of life balance. Why Syneos Health? Join a game-changing global company that is reinventing the way therapies are developed and commercialized. Here, you're essential in solving and executing against today's toughest commercialization challenges facing the world's leading healthcare companies. From the very beginning, you'll be supported by team members who, like you, aren't afraid to try something new. You'll gain exposure and work in a dynamic environment to create better, smarter, faster ways to get biopharmaceutical therapies to patients. WORK HERE MATTERS EVERYWHERE | How will you accelerate bringing Market Access solutions to clients? Syneos Health companies are affirmative action/equal opportunity employers (Minorities/Females/Veterans/Disabled) Apply for this job Syneos Health, Inc Phoenix AZ

Reimbursement Associate 163057

Preferred Homecare