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Description As a result of high cost injectable drugs being used in the practice, the pharmaceutical (drug) department was created specifically to perform the pre-visit process for these drugs, and to follow-up on unpaid balances, to ensure that the practice would be paid for these injected drugs. For each scheduled drug injection patient, this department is responsible for obtaining and/or verifying insurance coverage and eligibility, investigating drug benefits, obtaining pre-authorization (if necessary), communicating to the patient their financial responsibilities (including past due balances) for services to be provided by the physician as well as helping the patient to access any financial or co-pay assistance programs available. The drug department is responsible for making reasonable efforts to collect the patient portion prior to the injection. The drug department also addresses any drug related insurance claim denials or outstanding accounts receivable balances. Additionally, the drug department is responsible for accounting for, and the proper storing of, the inventory of these high cost drugs at each clinic location.

Responsibilities

• Interacting with patients face-to-face or via telephone regarding billing questions

• Composing effective appeal letters for initial and second level appeals

• Assessing account balances and make determination on further actions

• Provide co-pay assistance help to the patients- sending out packets, answering questions, enrolling online, and helping with information to qualify patients.

• Utilize payers’ websites to check claim and appeal status

• Answer the drug team queue calls from patients and clinics.

• Other duties as assigned

Requirements

• H.S. Diploma or equivalent (GED)

• Experience with medical billing and reimbursement requirements and procedures for government programs, private third-party insurance, and private individuals

• Experience analyzing and interpreting various types of insurance explanation of benefits and remittance advices

• General knowledge of credit and collection practices and basic accounting practices

• General knowledge of CPT and ICD10 policies related to medical billing

• Excellent math skills

• Excellent organization and communication skills

• Proficient in Microsoft Word, Excel, Outlook, and PowerPoint

• Must be able to learn and adapt to new processes

• Attention to detail and ability to multi¬task

• Ability to meet daily department goals

• Must be local to the Sacramento area

Preferred Qualifications:

• Minimum 5 + years of related medical billing experience (wiling to train the right person)

• Experience with NextGen

• Experience with Experian ClaimSource and Denial Manager

• Spanish speaking

Physical Requirements:

• Sitting and viewing computer screen for extended periods, up to 85% of the time

• Keyboarding, up to 90% of the time

• Standing, up to 25% of the time Requirements Medical Billing, Medical Collections, NextGen, Prescription Drug, Copays, Denial Management, Insurance Denials

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