Pharmacy Reimbursement Manager
Prochant US, United States
Job Description
Prochant is seeking an InfusionReimbursement Manager to work remotely. The Infusion Reimbursement Manager is responsible for managing the billing and collection function for all payer groups including Medicare / Medicaid. Responsible for escalating billing and/or collection issues. This is a highly collaborative role and the ideal candidate can both manage the day-to-day reimbursement as well as document and train other staff.
Essential Duties amp; Responsibilities
- Performs and manages the day-to-day reimbursement activities from delivery to payment process for all payer segments. This includes all aspects of the billing and collection functions as outlined in the individual job descriptions
- Monitors cash flow, days sales outstanding (DSO), and bad debt losses for payer segment by business to ensure profitability measures are met and maintained.
- Monitors billing requirements and receivables pursuant to contracts with third party payers or government programs.
- Ensures compliance with federal, state, and local governments, third party contracts, company policy, and general accounting practices.
- Manages and analyzes account summaries of outstanding receivable balances for negotiations or settlements.
- Revenue review and profitability reporting for accurate margins on a daily, weekly, monthly basis.
- Complete Month end required activities per company deadlines
- Reviews/statuses adjustments to claim balances and delinquent account transfers to collection agencies according to company procedures and policies.
- Acts as the first point of contact for escalation issues from the service provider regarding unresolved unknown deductions on payments received from payer or failure of payer to comply with contract terms as well as for billing and collections issues/claims.
- Provides input regarding procedures, develop strategies and new techniques to eliminate errors, increase to cash flow, reduction in avoidable bad debt loss, including recommended changes to billing practices, forms etc.
- Supports broader reimbursement team in the formulation of strategies relating to reimbursement management.
- Monitors adjustments to claim balances and delinquent account transfers to collection agencies according to company procedures and policies.
- Assist with training or onboarding of new employees
- Other duties as assigned
Requirements
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience
- 5+ years of home infusion billing and collections experience required
- Knowledge of financial reporting, HIPAA guidelines, federal, state, and local regulations related to healthcare providers, billing and collections
- Experience taking initiative and executing processes resulting in expected outcomes
- Experience with analyzing and reporting data to identify issues, trends, or exceptions to drive improvement of results and find solutions.
- Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction.
- CPR+, CareTend or Brightree systems experience preferred
- Excel, outlook, word experience
Benefits
Prochant offers some of the best benefits in the industry! We take great care of our employees. Prochant’s Fortune 500 level benefits package includes:
- Health Insurance
- Gap Insurance
- Dental Insurance
- Vision Insurance
- Short Term / Long Term Disability (company paid)
- Term Life Insurance (company paid, employee can elect additional)
- Full suite of supplemental insurance plans, including: Disability Income, Level Term Life, Accident Insurance, amp; Critical Illness Insurance
- Floating holidays and paid time off
- 401K with company match