Soleo Health
Description
Soleo Health is seeking a Billing Specialist to support our Infusion Branches Remotely (USA). Join us in Simplifying Complex Care.
What We Have to Offer You:
- Competitive Wages
- 401(k) with a match
- Referral Bonus
- Annual Merit Based Increases
- No Weekends or Holidays!
- Affordable Medical, Dental, & Vision Insurance Plans
- Company Paid Disability & Basic Life Insurance
- HSA & FSA (including dependent care) options
- Paid Time Off
- Education Assistant 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.
Requirements
- High School Diploma or equivalent
- 1+ years’ experience in medical billing preferred
- 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.
- The ideal candidate will have experience with infusion and specialty pharmacy billing
- CPR+ Software experience preferred