The Medical Billing and Collections Specialist supports the Finance organization with various duties related to billing and collection of customer accounts. The position also acts as a patient-focused liaison to assist customers with access to our products through the referral process. This position requires the ability to interact professionally with patients, insurance companies, institutions (including state programs, clinics, and other health professionals), as well as Cambrooke employees. The Revenue Cycle Specialist - ARC must be able collect and disseminate information relative to the company’s operating procedures and goals. This position sits in the corporate office in Ayer, MA. The core hours of operation are 8:30 am to 5:30 pm.

EDUCATION, CERTIFICATIONS, AND EXPERIENCE:

• Minimum High School Diploma or equivalent; College degree a plus.
• 10 years work experience in medical billing, eligibility, authorization, and interaction with payers
• Understanding of HCPCs and ICD10 coding
• Working knowledge of commercial and state payers claim processing and procedures (including Medicare, Medicaid, and WIC).
• Medical Terminology and/or Clinical Nutrition knowledge a plus.

KNOWLEDGE, SKILLS, AND ABILITIES:

• Proficiency in Microsoft Office; Excel, Word, Teams, etc.
• Previous experience with SalesForce or Nexternal preferred but not required.
• Ability to multi-task, with attention to detail to ensure accuracy.
• Able to prioritize work, anticipate department needs, plan accordingly and able to handle the many interruptions with ease.
• Strong written and oral communications skills required to provide excellent customer service and/or Revenue Cycle updates.
• Demonstrated sense of compassion and drive to ensure patient(s) and their families receive optimal coverage so they can receive Cambrooke products.
• Ability to work independently with minimal direction, take initiative within scope of work responsibilities
• Must be a strong team player working with the various Revenue Cycle Teams and be able to initiate activity and/or promptly communicate & mentor others.
• Must be organized and detailed oriented with a strong mathematical aptitude and ability to meet deadlines.
• Must have great listening skills to work with team members, other colleagues, and outside customers & clinics, to identify and initiate suggestions, guidance and/or resolution.
• Must be results and people-orientated having the ability to balance business and relationship
• Assist in the training and QA of new staff to implement client services functions.
• Knowledge of HIPPA and the ability to maintain confidential information security relative to all company’s proprietary information.
• Must maintain information security with regard to all company’s proprietary information.

WORKING CONDITIONS:

• Majority of work is completed in an office setting working inside a controlled temperature environment. Occasional work outside may be required to support employee events.
• May perform activities in an environment containing hazardous elements and requiring safety awareness and adherence to all safety and GMP policies and guidelines.
• Work must be performed in a safe manner for personal protection and for the protection of other team members.

PHYSICAL REQUIREMENTS:

• Position requires the ability to sit for a minimum of 6 hours per day
• Ability to stand, walk, bend over, and reach above head on a regular basis
• Ability to lift or carry up to 25 pounds occasionally and repetitive use of hands/arms for writing, filing, and computer work.
• Ability to wear safety shoes when in the manufacturing environment

PRIMARY RESPONSIBILITIES:

• Ensure Ajinomoto Cambrooke has necessary updated documentation to submit to third party payers.
• Filing and e-filing for all insurance claims following payer guidelines or instructions from Contracts and/or Single Case Agreements.
• Timely invoicing for patient balances and Institutional orders.
• Collection calls with payers and institutions until payment or resolution is obtained.
• Understanding and posting of payer denials so assigned Specialist can appeal accordingly based on payer guidelines and/or Case Agreements.
• Interacting with Client Services, Reimbursement Team, Sales, and Territory Managers to resolve or avoid issues as well as communicate updates.
• Research and resolution of internal and external credit clients’ billing queries.
• Understands the verbiage & complexity of Single Case Agreements and initiate discussion to address payer denials and claims processing.
• Interact with Client Services and Reimbursement team members to resolve or avoid payment issues & ensure prior orders are processed accordingly as stated in the SCA’s.
• Working knowledge of Pharmacy Benefits (PBM) and Durable Medical Equipment (DME) companies to ensure that patient(s) and their families can obtain the formula and medical foods they require based on benefit and insurance coverage.
• Working knowledge of the CambrookeCare process to provide assistance or explain benefits and claims processing based on contracts and/or agreements made to secure final payment.
• Contact healthcare professionals, state agencies, and payers (insurance companies) for clinical documents, eligibility, benefits, authorization, and any other items to ensure payment on an as needed basis.
• Ability to obtain and process credit card payments from patients or Institutional clients.
• Processing of cash receipts and creation of deposits.
• Processing of Financial Applications for patients experiencing financial hardship.
• Assisting with month end/year end close and reporting.
• Maintain medical records in compliance with HIPAA rules and regulations.
• Adhering to all company SOPs with regards quality and safety.
• Other duties as assigned.