• Job DescriptionJob DescriptionSupport the team with all billing, cycle management, and collections functions and ensure they are performed in a timely and accurate manner. Ensure all relevant input is complete, accurate, and fully adjudicated to ensure margin is maximized. Responsible for the integrity of all batches and their timely posting. Handle escalated billing issues and make sure full customer satisfaction is reached for residents, responsible parties and facility staff. Work with other departments as it relates to billing and claims adjudication.ESSENTIAL JOB FUNCTIONS (include the following):Monitor billing, A/R, and collection functions to ensure high level of customer service is maintained

Review and research rejected Third-Party claims taking appropriate action to resolve.
Work backlog of denied claims for timely resubmission.
Assist in month end close processes, including statement prep, analysis reports, etc.
Monitor assigned queues keeping up-to-date and current on all claims.
Ensure all claims are adjudicated and batches composited and/or posted in a timely manner
Ensure the PA/rejection queue is updated and resolved in a timely manner
Monitor the cycle management process including delegating tasks, accordingly, ensuring any issues are followed up on and addressed appropriately
Answer incoming calls related to billing issues. Resolve issue or forward to appropriate authority as needed.
Work with DFA to lead team in development and ongoing updates for all operations training manuals to assist in new employee training process; ensure written policies and procedures are maintained and updated for each area/function
Work collaboratively with co-workers to ensure all deadlines for department are met in an efficient manner.
Work with various department leaders in order to assist/support clearing bottlenecks in workflow and ensuring the most efficient processes are followed
Become cross trained in all areas of department function
Lead by example in all areas of role and supporting the non-negotiable attributes: attitude, dependability, commitment, productivity, efficiency and upholding policies and procedures
Follow all applicable government regulations including HIPAA.
Other essential functions and duties may be assigned as needed
EDUCATION AND/OR CERTIFICATIONSHigh School Diploma or GED required; Bachelor's Degree preferred
Pharmacy Technician license/certification/registration (per state requirements); National Certification preferred (PTCB) may be required (pharmacy specific).
SKILLS AND QUALIFICATIONS:2+ years of related experience (advanced degree may substitute for experience)
Advanced computer skills; pharmacy operations system experience preferred
Ability to work independently and deliver to deadlines
Ability to solve problems with minimal direction
Great attention to detail and accuracy
Ability to excel in a fast-paced, team-oriented environment working on multiple tasks simultaneously, while adhering to strict deadlines
Quality minded; motivated to seek out errors and inquire when something appears inaccurate
Pharmacy, managed care, Medicaid and/or Medicare experience
ATTRIBUTES REQUIRED:Work Ethic/Integrity – must possess intrinsic drive to excel coupled with values in line with company philosophy
Leadership – ability to lead project teams to deadlines, while maintaining strong team orientation
Strategy and Planning – ability to think ahead, plan and manage time efficiently
Problem Solving – ability to analyze causes and solve problems at both a strategic and functional level
Team Oriented – ability to work effectively and collaboratively with all team members
LANGUAGE SKILLS:Ability to communicate clearly and concisely in verbal and written form
Strong communication skills and a customer service attitude
Must be able to frequently communicate with customers and/or with others about customer’s requirements, complaints, and common inquiries.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the job.While performing the duties of this job, the employee is regularly required to communicate with others inside and outside the pharmacy, including the ability to express oneself and exchange information in what, at times, could be a stressful or high-pressure environment.
The employee frequently is required to move about the office/pharmacy to access files, use office equipment, and to interact with others. The person must be able to sit or remain in a stationary position for extended periods of time to be able to work, communicate on the phone, utilize the computer, and interact with others. The employee is occasionally required to stand or otherwise be able to access files, equipment, and other items in high places.
Employee must be able to constantly operate computers, phones, and other office equipment.
Employee must be able to bend, stoop, kneel, crouch, or crawl.
Specific vision abilities required by this job include close vision, color vision, and ability to adjust focus.
WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the job.The noise level in the work environment is usually low to moderate.
Due to the collaborative nature of the business and the need to service customers, the employee must be able to interact effectively with others in an office environment, manage conflict, and handle stressful situations and deadlines.
Requires desk work in office environment.
Ability to work flexible hours
FLSA STATUS: Non-ExemptConsistent with applicable federal and state laws, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.This description reflects the Company’s assessment of the essential functions of the job but does not proscribe or restrict other tasks that may be assigned from time to time. Duties, responsibilities, and activities may change at any time with or without notice.I confirm that I am able to perform the functions and requirements of this position, with or without reasonable accommodations, as described herein and explained to me.

• Job PostingJob PostingSchedule: M-F 9am to 5pmPrior experience in medical billing at a doctor's office requiredDME billing experience preferred but not requiredThis role will be performed hybrid at a closed-door pharmacy in Cincinnati, OH (Forest Park).All patient interactions will be over the phone.Comprehensive training provided side by side with training team.Must be comfortable working in a high-volume environment.We offer full time benefits including health, vision, dental and matching 401k options.Responsible for preparing and submitting claims for prescription medications and works with nursing facility staff, physician offices, and insurance companies to ensure timely payment of online submission of claims.

Attributes Required:
• Work Ethic/Integrity – must possess intrinsic drive to excel coupled with values in line with company philosophy
• Leadership – ability to lead project teams to deadlines, while maintaining strong team orientation
• Strategy and Planning – ability to think ahead, plan and manage time efficiently
• Problem Solving – ability to analyze causes and solve problems at both a strategic and functional level
• Team Oriented – ability to work effectively and collaboratively with all team members

Essential job functions (include the following):

• Review and research rejected Third-Party claims taking appropriate action to resolve.
• Process daily admits, obtain/verify insurance, and mail customer agreements.
• Prepares and processes Prior Authorization forms
• Work backlog of denied claims for timely re-submission.
• Manage assigned queues keeping up-to-date and current on all claims.
• Workflow grid is cleared daily meet productivity criteria
• Specific denials including new patient overrides
• Assist in the regular billing invoice production process.
• Follow all applicable government regulations including HIPAA.
• Prepare bi-weekly work schedules
• Assist the supervisor with training staff on new insurance processing requirements
• Answer incoming calls related to billing issues. Resolve issue or forward to appropriate authority as needed.
• Work collaboratively with co-workers to ensure all deadlines for department are met in an efficient manner.
• Other essential functions and duties may be assigned as needed

Education and/or Certifications:

• High School Diploma or GED
• Pharmacy Technician License preferred

Skills and Qualifications:

• 2+ years of related experience (advanced degree may substitute for experience)
• Advanced computer skills; pharmacy operations system experience preferred
• Ability to work independently and deliver to deadlines
• Ability to solve problems with minimal direction
• Great attention to detail and accuracy
• Ability to excel in a fast-paced, team-oriented environment working on multiple tasks simultaneously, while adhering to strict deadlines
• Quality minded; motivated to seek out errors and inquire when something appears inaccurate
• Pharmacy, managed care, Medicaid and/or Medicare experience

Job Type: Full-time

Pay: Up to $30.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

COVID-19 considerations:
N/A

Work Location: Hybrid remote in Cincinnati, OH 45240

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