Billing Specialist

Description

Soleo Health is seeking a Billing Specialist to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care!

Home infusion billing experience required.

• Competitive Wages
• 401(k) with a Match
• Referral Bonus
• Paid Time Off
• Great Company Culture
• Annual Merit Based Increases
• No Weekends or Holidays
• Paid Parental Leave Options
• Affordable Medical, Dental, and Vision Insurance Plans
• Company Paid Disability and Basic Life Insurance
• HSA and FSA (including dependent care) Options
• Education Assistance Program

The Position

The Billing Specialist will primarily be responsible for insurance and self-pay billing, excluding Medicare. This role is also responsible for submitting electronic and paper claims. Follows up with clearing house vendors on accepted and working rejections.

Responsibilities include

• Preparation of accurate medical claims based on contracted agreements for services to various payers (e.g. Commercial Payers, Government Payers, Employer/ Institutional Payers).
• Reviewing and identifying claims pricing discrepancies based on updates/changes to fee schedules.
• Creates and submits secondary electronic pharmacy and medical claims in a timely manner.
• Billing of manufacturer copays, which includes entering the necessary information into portal or billing via paper at time of initial billing.
• Monitors billing requirements pursuant to contracts with third party payers or government programs.
• Answer insurance/billing questions from branch staff and help educate.
• Review information from electronic medical records in patient account (IE: auth, benefit verification, orders, accounts receivable, etc.) to ensure preparation and submission of clean claims.
• Perform routine revenue review of claims billed within the current month.
• Answering incoming calls and triage if necessary.
• Create claim batches and process them via electronic submission.
• Manually process any claims that are not eligible for electronic billing. Identify any claims that need attention, make corrections, and resubmit.
• Ensure coding to the highest level of specificity and for maximum reimbursement by third party payers.
• Daily review and follow up of unbilled delivery tickets in billing review and ready to bill queues.
• Accurately notate patient accounts to reflect all actions made including marginal, split claim notes, missing COGS, etc.
• Coordinates with the pharmacy team daily to ensure any PBM issues are addressed and resolved, accepted into revenue and billed timely
• Effectively utilize time and resources to meet performance goals.
• Provides exceptional Customer service to internal and external customers.
• Ensures compliance with federal, state, and local governments, third party contracts, and company policies.
• Clearly communicate any billing related issues to all appropriate parties including: Intake, collections, RBL, and manager.
• Monitoring the unbilled-pending invoices queues and communicate to the branch on missing or needed documents or information.
• Maintain current knowledge of departmental and organizational policies.

Schedule

• 8:30a-5p, Monday-Friday

Requirements

• 2 years or more of home infusion billing required
• High School Diploma or equivalent
• Knowledge of HCPC coding and medical terminology
• Experience providing customer service to internal and external customers
• Must be computer literate
• Must be dependable. Excellent phone and email communication skills.
• Working knowledge of ICD10, CPT, NCCI; must be familiar with modifier application and standard billing regulations

About Us: Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services, administered in the home or at alternate sites of care. Our goal is to attract and retain the best and brightest as our employees are our greatest asset. Experience the Soleo Health Difference!

Soleo’s Core Values

• Improve patients’ lives every day
• Be passionate in everything you do
• Encourage unlimited ideas and creative thinking
• Make decisions as if you own the company
• Do the right thing
• Have fun!

Soleo Health is committed to diversity, equity, and inclusion. We recognize that establishing and maintaining a diverse, equitable, and inclusive workplace is the foundation of business success and innovation. We are dedicated to hiring diverse talent and to ensuring that everyone is treated with respect and provided an equal opportunity to thrive. Our commitment to these values is evidenced by our diverse executive team, policies, and workplace culture.

Soleo Health is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for all employees. Soleo Health does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non-merit factor.

Keywords:billing representative, accounts receivable, collections, claims, medical coding and billing