Independent Health — Батыс Нью-Йоркте жұмыс істейтін денсаулық сақтандыру ұйымы және аймақтағы алғашқы медициналық қызмет көрсету ұйымдарының (HMO) бірі. Ол 100-ден астам жоспар, өнім және қызмет арқылы шамамен 355 000 адамға сақтандыру өтемін және оған байланысты қызметтер ұсынады. Компанияның қызмет бағыттарына коммерциялық медициналық сақтандыру, дәріхана жеңілдіктері, Medicare Advantage және өзін-өзі қаржыландыратын медициналық жоспарлар кіреді. Компания өз мәдениетін мүшелер мен қызметкерлерге өз мүмкіндіктерін барынша ашуға көмектесуге бағытталған деп сипаттайды.
Hybrid Billing Specialist - Pharmacy and Medical Claims
Process pharmacy and medical claims for Reliance Rx specialty pharmacy in a hybrid Williamsville role. Resolve rejections, payor issues, patient assistance needs, and portal activity.
Сипаттама
- Process and adjudicate pharmacy and medical claims, including rejected claims
- Track rejected claims, complete follow-up, and help meet delivery commitments
- Serve as a point of contact between patients and insurance providers
- Coordinate communication among patients, physicians, clinical staff, and administrative teams
- Work with payors to investigate and resolve billing concerns
- Maintain Reliance Rx compliance with CMS requirements and Medicare and Medicaid guidance
- Verify claim accuracy along with payor billing and shipping requirements
- Prepare and arrange deliveries to medical offices
- Submit medical claims for medications and supplies
- Validate the financial details of claims before they leave the facility
- Administer the portal, including refill reminders, portal orders, and patient enrollment
- Arrange patient financial assistance through foundations, copay programs, and free medication services
- Support Patient Care Specialists with workflow coordination and inbound and outbound calls
- Maintain patient files and complete required filing and documentation
- Complete system setup and data-entry activities
- Manage payment arrangements and collect copayments
- Support medical offices with prior authorization requests
- Coordinate insurance benefits
- Encourage information sharing and ongoing process improvements
- Follow established written procedures and guidelines, obtaining supervising pharmacist approval for deviations
Талаптар
- High school diploma or GED is required
- National Pharmacy Technician Certification (CPhT) is preferred
- At least one year of experience in a high-volume pharmacy or comparable setting is required; six months as a temporary associate in Reliance Rx Operations & Compliance may qualify
- Experience with an online claims processing system is preferred
- Strong verbal and written communication skills
- Comfort working with other healthcare professionals
- Ability to lift at least 5 pounds
- Demonstrated alignment with Reliance values: Collaborative, Accessible, Results-Oriented, Empowering, and Supportive
- This position does not offer immigration or work visa sponsorship
Артықшылықтар
- Scorecard-based incentive
- Comprehensive benefits package
- Generous paid time off