Reimbursement Specialist /Collectors (Multiple Roles, Beverly Hills & Laguna Hills, CA)

About AmeriPharma

AmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. We like people who are passionate about their roles and people who like to grow and change as the company evolves.

AmeriPharma’s Benefits

• Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
• Great pay and general compensation structures
• Employee assistance program to assist with mental health, legal questions, financial counseling etc.
• Comprehensive PTO and sick leave options
• 401k program
• Plenty of opportunities for growth and advancement
• Company sponsored outings and team-building events
• Casual Fridays

Job Summary

We are seeking Reimbursement Specialists, from entry-level to experienced, to join our dynamic team. The ideal candidate will be responsible for ensuring accurate and timely collections to maximize reimbursement experience. This role is essential in ensuring accurate and timely collections and maximizing reimbursement through effective interactions with third-party payers, insurance plans, and patients. The candidate will possess strong analytical skills, be detail-oriented, and excel in submitting claims, appeals, and resolving discrepancies with minimal supervision.

Schedule Details

• Location: On-Site (Beverly Hills or Laguna Hills, CA)
• Hours: Monday to Friday, 8am-4:30pm

Duties and Responsibilities

Entry-Level Reimbursement Specialists provide essential support in managing patient accounts and ensuring the timely recovery of payments. The primary focus of this role is administrative support for Accounts Receivable (AR) management, including reviewing the patient inventory of assigned accounts and collecting on open AR inventory to meet our goal of receiving reimbursements within 60 days of the billed date. Key responsibilities involve correlating insurance coverage with services to be provided, preparing and reviewing insurance claims, and ensuring that all Copay Assistant claims are billed promptly to the appropriate Foundation. This role involves general collections on patient balances, managing all assigned correspondence before due dates, and actively assisting in maintaining a positive Days Sales Outstanding (DSO) on the assigned account inventory.

Experienced Reimbursement Specialists

Self-directed Experienced Reimbursement Specialists manage all aspects of the Accounts Receivable (AR) life cycle for assigned patient accounts. The primary objective is to maintain financial health by aggressively collecting on all open AR inventory and patient balances, ensuring that reimbursements are received within 60 days of the billed date and consistently maintaining a positive Days Sales Outstanding (DSO) on the assigned account inventory. This expert role involves correlating insurance coverage with services, preparing and reviewing complex insurance claims, and ensuring all Copay Assistant claims are billed in a timely manner to the appropriate Foundation.

The Work Includes

• Actively collecting on open AR to ensure payment within 60 days of billing, managing and responding to correspondences by their due dates, reviewing contracts and fee schedules for accurate reimbursement, and verifying insurance coverage alignment with services provided.

• Auditing open inventory, verifying and following up on insurance claims and accounts receivable, ensuring timely billing for Copay Assistant claims, collaborating with other departments for necessary documentation, and answering incoming calls.

• Submitting appeals and pursuing additional payments on any medical claims denied in error or paid less than the expected reasonable maximum allowable rate for the procedure codes submitted and level of patient’s benefit coverage
• Navigating complex insurance policies, ensuring the accuracy of received reimbursement payments, reviewing the accuracy of submitted claims, and communicating process inefficiencies or billing errors that lead to claim denials or underpayments to team members and management.

• Perform other duties assigned by management

Required Qualifications

• Ability to read, write, speak, and understand the English language fluently.
• Ability to collaborate with other team members and management for all pharmacy needs.
• Strong time management, communication, multitasking and organizational skills.
• High attention to detail and strong analytical and problem-solving skills.
  
• Ability to work collaboratively in a fast-paced team environment.
• Ability to work independently and meet deadlines with minimal supervision.
• Strong attention to detail with the ability to type accurately and analyze data.
• Ability to apply logical thinking to solve complex and practical problems.
• Flexible and able to work hours that ensure timely completion of projects and duties.

Education and Experience Requirements

• High School Diploma or equivalent.
• Minimum of 1 year of hands-on experience in medical coding/billing with a working knowledge of managed care, commercial insurance, Medicare and Medicaid reimbursement required.
• Experienced specialists will have in depth Knowledge of managed care, commercial insurance, ICD-10, CPT, HCPC codes, J billing codes, and
  • medical terminology, along with CMS HCFA 1500 forms & Electronic Billing, and n-depth understanding of healthcare billing and coding processes.
  • Experience with Benefit Investigation and Patient Responsibility Agreements.
  • Experience with automated billing systems, CPR+ is preferred.
  • Advanced proficiency in Microsoft Word, Excel, and Outlook.

AmeriPharma’s Mission Statement

Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients. It is our joint and individual responsibility daily to demonstrate to outpatients, prescribers, colleagues, and others that We Care!

Physical Requirements

The following physical activities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions and expectations

EEO Statement

The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The duties and responsibilities of this position are subject to change and other duties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, age, protected veteran status, or on the basis of disability or any other legally protected class.