Responsibilities

• Daily communication with the pharmacy regarding patient demographic details and prescription orders
• Work in conjunction with pharmacy to invoice patients and daily reconciliation of prescriptions
• Entry of billable items into the practice management system
• Handle patient intake phone calls and email inquiries, review light clinical information, and review in-network insurance information with the patient
• Verify patient eligibility and benefits and provide details
• Review of orders with patients to include employer benefit coverage and out-of-pocket responsibilities
• Respond to and complete internal communication flags of patients needing to be contacted or problems that need to be resolved.
• Answer any incoming patient emails on financial matters, triaging any non-financial needs or questions
• Maintains current knowledge in pharmacy billing requirements related to employer/third-party
• Effective communication abilities for phone contacts with insurance payers to resolve issues
• Customer service skills for interacting with patients regarding medical claims and payments
• Research and resolve any discrepancies, denials, appeals, collections
• Set up patient payment plans and work collection accounts
• Review patient bills for accuracy and completeness and obtain any missing information
• Process claims and post payments.
• Process insurance payments, including balance billing to secondary insurance and/or directly to patients.
• Ensure timely follow-up on all unpaid claims utilizing monthly aging reports
• Analyze rejected and outstanding claims, troubleshoot errors and rejection codes, and correct and re-submit all denied claims.
• Properly note the system and maintain all documentation required for compliant claim submission.
• Prepare and process refund requests.
• Verify and post patient amounts.
• Respond to a high volume of telephone inquiries in a positive and professional manner, and resolve and follow up on all issues within designated timeframes.
• Meet positional metrics and benchmarks.
• Maintain the highest degree of ethics when handling patient payments and bill processing
• Follow all department standard operating procedures carefully and accurately
• Other duties as assigned by the Director.

General Administrative Duties

• Manage inbound customer communication (phone, email & chat) and ensure all messages are answered in a timely fashion
• Maintain clear communication with the clinics about overall clinic operations
• Other duties and projects as assigned

Who You Are

• 2+ years of healthcare experience in a fast-paced, customer-focused environment, Fertility financial experience, and pharmacy a plus
• A passion for women’s health, and fertility is a plus
• Strong written and verbal communication skills & a team player
• Willingness to be flexible, roll with the punches, multi-task, and troubleshoot problems
• Detail-oriented with strong organizational skills
• Exemplifies amazing customer service skills and professionalism
• Experience in CPT and ICD-10 coding; familiarity with medical terminology
• Ability to manage relationships with various insurance payers
• Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement.
• Certificate from an accredited medical and billing school.