Reimbursement Specialist - Billing

The Reimbursement Specialist is accountable for performing all initial billing functions for commercial/government and pharmacy plan claims in accordance with the Clean Claims Act requirements. The primary goal for this position is to ensure that all Billing and Collections functions for 0-90 day accounts receivable (AR) are performed timely, accurately and in adherence to Pentec Health’s compliance program. 

Essential Job Duties:  

• Submit accurate and timely Clean Claims for the required invoice type (CMS 1500, 835 – Electronic Medical Claims, and NCPDP 5.1 – Pharmacy).
• Use professionalism and tact to build and maintain relationships with payor representatives.
• Bill patient for copays and deductibles as appropriate, verify accuracy of charges, correct errors in accounts as needed and address claims for appeal process. Investigate complaints and resubmit claims as appropriate.
• Protect patient confidentiality, according to HIPPA guidelines. Maintain correct patient records and documentation of all correspondence and status.

*Other job duties and special projects as assigned. 

Ideal Candidate Will Have:  

• High School diploma with a minimum of 2 years hands-on experience in a billing or collections role within a physician office, specialty infusion, home care or related field required.
• Ability to calculate drug dispensed based on prescription/order and amounts such as interest and percentages accurately; Dependable with the ability to adhere to deadlines.
• Proficiency with Microsoft Windows, Outlook, Word and Excel (pivot tables); Skilled in CPR or a similar platform.
• Team oriented while meeting pressures of deadlines and productivity standards; Effective listening and customer service skills; Problem solving and troubleshooting skills; Clear effective communication skills in English language. 

Physical Requirements:

The physical demands 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. 

While performing the duties of this job, the employee is frequently required to stand, sit, walk, see, hear, use hands and fingers regularly, handle, or feel objects, tools, or controls, and reach with hands and arms. 

The employee must frequently lift and/or move up to 5 pounds and occasionally lift and/or move up to 40 pounds. 

Salary Range: $21.00-$22.00 an hour 

Pentec Health offers a comprehensive compensation and full benefits package. Actual pay will be based on several factors such as qualifications and skills for the role plus geographic location. 

Benefits may include but are not limited to medical, dental, vision, 401k match, PTO, paid holidays, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits