Overview
Job Summary: The Revenue Cycle Management Specialist- Biller responsibility is to manage the process of the company's billing function including accurate and timely claim creation and submission.
Responsibilities
Accurately prepare and submit claims for payment from all third-party payers in a timely manner.
Verify documentation of supplied products align with prepared claim.
Verify accuracy of billed codes and accuracy of billed and expected amounts.
Support the resolution of billing issues such as claim resubmissions to all payers, changes in coverage, and claims
Follow up on submitted claims and resolve rejected claims, including claim corrections, update payer ID, update patient insurance record, etc.
Prepare and submit patient statements.
Communicate as needed with patients about billing issues, including the results of applications for financial hardship assistance and other responses to customer inquiries about
Support accurate and comprehensive record-keeping to ensure up-to-date information is maintained and effectively shared across departments.
Assist in the implementation of processes to measure, assess, and improve the performance of the billing department activities of the company.
Ensure ongoing compliance with all laws and regulations; ensure that the department meets or exceeds accreditation standards; and implement "best practices" in all departmental
Participate in surveys conducted by authorized inspection
Participate in the company's Performance Improvement program as requested by the Performance Improvement
Participate in company committees when
Participate in in-service education programs provided by the company.
Pursue continuing education programs appropriate to job
Perform other duties as assigned by
Complete all mandatory and regulatory training programs.
Report any misconduct, suspicious or unethical activities to the Compliance
Complies with accepted professional standards and practice.
Qualifications
Educational Requirements:
Experience:
Job Skill Requirements:
Ability to read and interpret medical records for billing purposes.
Competent in mathematic equations.
Ability to compute unit conversions for drugs.
Understanding of CPT, HCPCS, and ICD-10 codes
Has excellent attention to detail and communication skills.
Understanding of HIPAA compliance.
Self-directed, has the ability to work with little supervision.
Proficiency in Excel, Outlook, and all other office applications.
Familiarity with pharmacy management systems (CPR+, Wellsky, and CareTend, etc.)
Familiar with billing requirements for various payers (Medicare, Medicaid, Commercial, etc.)
Knowledge and experience submitting pharmacy and medical claims electronically or on paper.
KPH Healthcare Services is a healthcare company that specializes in home infusion and specialty pharmacy services. The company manages the complete revenue cycle for their billing operations, including claim creation, submission, and management across multiple third-party payers such as Medicare, Medicaid, and commercial insurers. They focus on maintaining compliance with healthcare regulations including HIPAA while delivering comprehensive billing and administrative services to support their clinical operations.
