Reimbursement Counselor
Company Name:
AmerisourceBergen Atlanta
## Description
Under the general supervision of the Reimbursement Supervisor / Manager is responsible for various reimbursement functions including but not limited to accurate and timely claim submission claim status collection activity appeals payment posting and/or refunds until accounts receivable issues are properly resolved.
Shift 11:00am - 8:00pm
1. Collects and reviews all patient insurance benefit information to the degree authorized by the SOP of the program.
2. Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications.
3. Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payors. Researches and resolves any electronic claim denials.
4. Effectively utilizes various means for collections including but not limited to phone fax mail and online methods.
5. Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
6. Maintains frequent phone contact with provider representatives third party customer service representatives pharmacy staff and case managers.
7. Reports any reimbursement trends/delays to supervisor (e.g. billing denials claim denials pricing errors payments etc.).
8. Processes any necessary insurance/patient correspondence.
9. Provides all necessary documentation required to expedite payments. This includes demographic authorization/referrals National Provider Identification (NPI) number and referring physicians.
10. Coordinates with inter-departmental associates to obtain appropriate medical records as they relate to the reimbursement process.
11. Maintains confidentiality in regards to patient account status and the financial affairs of clinic/corporation. Communicates effectively to payors and/or claims clearinghouse to ensure accurate and timely electronically filed claims.
12. Researches and resolves any claim denials or underpayment of claims.
a. Job Complexity: Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action. Builds productive internal/external working relationships.
b. Supervision: Typically receives little instruction on day-to-day work general instructions on new assignments.
13. Performs related duties as assigned.
## Qualifications
Requires broad training in fields such as business administration accounting computer sciences medical billing and coding or similar vocations generally obtained through completion of a two year associate's degree program technical vocational training or equivalent combination of experience and education. Two (2) years directly related and progressively responsible experience preferred.
1. Ability to communicate effectively both orally and in writing.
2. Strong interpersonal skills.
3. Strong negotiating skills.
4. Strong mathematical skills.
5. Strong organizational skills; attention to detail.
6. General knowledge of accounting principles pharmacy operations and medical claims.
7. General knowledge of HCPCS CPT ICD-9 and ICD-10 coding preferred.
8. Global understanding of commercial and government payers preferred.
9. Ability to proficiently use Microsoft Excel Outlook and Word.
10. Developing professional expertise; applies company policies and procedures to resolve a variety of issues.
Organization: TheraCom
Job: Customer Service & Call Center
Schedule: Full-time
Primary Location: United States-Maryland-Rockville
Req ID: 000015K2Estimated Salary: $20 to $28 per hour based on qualifications.
AmerisourceBergen Atlanta
## Description
Under the general supervision of the Reimbursement Supervisor / Manager is responsible for various reimbursement functions including but not limited to accurate and timely claim submission claim status collection activity appeals payment posting and/or refunds until accounts receivable issues are properly resolved.
Shift 11:00am - 8:00pm
1. Collects and reviews all patient insurance benefit information to the degree authorized by the SOP of the program.
2. Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications.
3. Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payors. Researches and resolves any electronic claim denials.
4. Effectively utilizes various means for collections including but not limited to phone fax mail and online methods.
5. Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
6. Maintains frequent phone contact with provider representatives third party customer service representatives pharmacy staff and case managers.
7. Reports any reimbursement trends/delays to supervisor (e.g. billing denials claim denials pricing errors payments etc.).
8. Processes any necessary insurance/patient correspondence.
9. Provides all necessary documentation required to expedite payments. This includes demographic authorization/referrals National Provider Identification (NPI) number and referring physicians.
10. Coordinates with inter-departmental associates to obtain appropriate medical records as they relate to the reimbursement process.
11. Maintains confidentiality in regards to patient account status and the financial affairs of clinic/corporation. Communicates effectively to payors and/or claims clearinghouse to ensure accurate and timely electronically filed claims.
12. Researches and resolves any claim denials or underpayment of claims.
a. Job Complexity: Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action. Builds productive internal/external working relationships.
b. Supervision: Typically receives little instruction on day-to-day work general instructions on new assignments.
13. Performs related duties as assigned.
## Qualifications
Requires broad training in fields such as business administration accounting computer sciences medical billing and coding or similar vocations generally obtained through completion of a two year associate's degree program technical vocational training or equivalent combination of experience and education. Two (2) years directly related and progressively responsible experience preferred.
1. Ability to communicate effectively both orally and in writing.
2. Strong interpersonal skills.
3. Strong negotiating skills.
4. Strong mathematical skills.
5. Strong organizational skills; attention to detail.
6. General knowledge of accounting principles pharmacy operations and medical claims.
7. General knowledge of HCPCS CPT ICD-9 and ICD-10 coding preferred.
8. Global understanding of commercial and government payers preferred.
9. Ability to proficiently use Microsoft Excel Outlook and Word.
10. Developing professional expertise; applies company policies and procedures to resolve a variety of issues.
Organization: TheraCom
Job: Customer Service & Call Center
Schedule: Full-time
Primary Location: United States-Maryland-Rockville
Req ID: 000015K2Estimated Salary: $20 to $28 per hour based on qualifications.
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