Medical Billing Specialist
Description
Medicines are powerful – they can prevent and heal disease, but they can also be costly, ineffective or even harmful if not prescribed and taken correctly. The team at Mosaic Pharmacy Service is helping people get more from their medicines™.
Mosaic Pharmacy Service a one-of-a-kind pharmacy experience. The patients don't come to us, we ship to them! This model allows our pharmacy team to do their best work without interruptions and gives our patients the white glove delivery experience of receiving their meds in our innovative easy-to-use packaging.
Mosaic Pharmacy Service is a "closed door" pharmacy that provides comprehensive pharmacy care to medically complex and vulnerable seniors, across the country. We provide a patient-focused, pharmacist-driven care model in collaboration with health systems, assisted living facilities and health plans. Our goal is to help our patients feel better about the medications they take every day by simplifying medication regimens, improving adherence, and driving positive outcomes. Mosaic is looking for caring, motivated, and creative individuals to join our team for an innovative new career opportunity.
Job Profile
The Medical Billing Specialist, known internally as a Payment Resolution Specialist, will be responsible for ensuring our patients’ and pharmacy billing needs are met satisfactorily. Our Payment Resolution Specialist will help coordinate patient payments and issue resolution between the patient and pharmacy. This includes but is not limited to resolving declined credit/debit cards, payment plan enrollment and management, third-party claims resolution, and speaking directly with patients about their billing. This position reports directly to the Manager of Revenue Cycle Management.
Key responsibilities include the following
- Represents Mosaic to its members over the telephone, with excellent customer service skills and attention to detail.
- Answers inquiries from patients regarding health plan drug coverage, prices, and related issues.
- Communicates with patients regarding insurance coverage, copayments, and billing inquiries with exceptional customer service.
- Able to resolve rejected or denied pharmacy claims, working with patients and PBMs to resolve
- Identifies situations when patient should speak with pharmacist and appropriately triages to the pharmacist.
- Collaborates with pharmacy staff to ensure proper billing codes and documentation are maintained.
- Stays current with changing insurance regulations, billing requirements, and industry best practices.
- Identifies opportunities for process improvements to enhance billing efficiency and accuracy.
- Maintains patient confidentiality and complies with HIPAA regulations at all times.
- Perform other tasks as assigned.
Requirements
- High School Degree or GED equivalent required; Associate's degree in healthcare administration or related field preferred
- Ability to pass drug screen and criminal background check.
- 2+ years of experience in pharmacy billing, medical billing, or healthcare revenue cycle management and strong knowledge of insurance billing processes, including Medicare Part D, Medicaid, and commercial insurance.
- Experience working with pharmacy management systems and billing software
- Understanding of pharmacy benefit management (PBM) operations.
- Excellent analytical and problem-solving skills.
- Strong attention to detail and accuracy in data entry.
- Exceptional written and verbal communication skills.
- Ability to work independently and manage multiple priorities.
- Proficiency in Microsoft Office Suite
- Virginia Pharmacy Technician license a plus.