Hours:

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Weekend Requirements:

On-Call Required:

Hourly Pay Range (Minimum - Midpoint - Maximum):

The stated pay scale reflects the range that Sharp reasonably expects to pay for this position.  The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant’s years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do
To manage all aspects of the revenue cycle for the post-acute patient population under the Home Infusion and Specialty Pharmacy programs. Including billing and collections to all payers through resolution of the accounts. This includes appeals and grievances with all payers and pursuit of private pay balances through collection.

Required Qualifications

• H.S. Diploma or Equivalent
• 5 Years experience in all areas of billing.

Preferred Qualifications

• 4 Years experience in billing in a health care setting.

Essential Functions

• Teamwork and Collaboration
  Work directly with onsite pharmacy technicians and clinical evaluator to complete all aspects of the admission process for specialty pharmacy patients. Create patient account with all appropriate demographic information.
  Verify benefits and add insurance plans.
  Review the medication profile and contact the patient prior to coming onto service to explain any copay amounts associated with the drug and tier level of the medication.
• Account Management
  Ensure accuracy of the account monthly and at each dispense, verifying and updating authorization throughout the entirety of the visit.
  Work directly with the pharmacist to review prescription and allocated per diems for all services.
  Submit weekly claims to all payers, including private pay statements. Review copay card options with patients to qualify for supplemental funding and submit claims appropriately to all copay card eligible programs.
  Review account after payment for correct balance and apply necessary adjustments if needed.
  Review credit balance and reverse contractual adjustments when appropriate.
  Commence direct follow-up action on unpaid accounts according to payer time frames.
  Monitor accounts within assigned rep work list via use of delinquency reports, team trend report, monthly aging and special reports
• Financial Analysis and Reporting
  Successfully file appeals/PDRs on non-clinical underpaid/denied claims.
  Explain new legislation impacting underpayments/denials etc.
  Trend and identify underpayment/denial issues for training purposes with the goal of mitigating future underpayments/denials.
  Ensure the current quarterly, monthly, yearly insurance rates are obtained and loaded into the contract module for accurate and expected rate analyzation.
• Productivity
  Focus appeal efforts on underpayment/denials with highest propensity for recovery, considering payor appeal timeframes, contract reimbursement, underpaid/denied reason.
  Complete all special projects via assigned ATB and maintain productivity standards within department guidelines.
  Participate in the achievement of cash collection goal through timely follow-up activity.

Knowledge, Skills, and Abilities

• General knowledge of office procedures and ability to utilize resources in an organized manner.
• Knowledge of benefits, covered services, and billing procedures of all Government and non-Government insurance programs.
• Familiarity with regulations governing collection proceedings.
• Knowledge of ICD-10 and CPT-4 codes, and basic medical terminology.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class