[Hiring] Billing Specialist @Soleo Health Inc

Role Description

Soleo Health is seeking a Billing Specialist to support our Specialty Infusion Pharmacy and work Remotely (USA). Join us in Simplifying Complex Care!

The Billing Specialist will primarily be responsible for insurance and self-pay billing, excluding Medicare. This role is also responsible for submitting electronic and paper claims and follows up with clearing house vendors on accepted and working rejections.

• Preparation of accurate medical claims based on contracted agreements for services to various payers (e.g. Commercial Payers, Government Payers, Employer/ Institutional Payers).
• Reviewing and identifying claims pricing discrepancies based on updates/changes to fee schedules.
• Creates and submits secondary electronic pharmacy and medical claims in a timely manner.
• Billing of manufacturer copays, which includes entering the necessary information into portal or billing via paper at time of initial billing.
• Monitors billing requirements pursuant to contracts with third party payers or government programs.
• Answer insurance/billing questions from branch staff and help educate.
• Review information from electronic medical records in patient account (IE: auth, benefit verification, orders, accounts receivable, etc.) to ensure preparation and submission of clean claims.
• Perform routine revenue review of claims billed within the current month.
• Answering incoming calls and triage if necessary.
• Create claim batches and process them via electronic submission.
• Manually process any claims that are not eligible for electronic billing. Identify any claims that need attention, make corrections, and resubmit.
• Ensure coding to the highest level of specificity and for maximum reimbursement by third party payers.
• Daily review and follow up of unbilled delivery tickets in billing review and ready to bill queues.
• Accurately notate patient accounts to reflect all actions made including marginal, split claim notes, missing COGS, etc.
• Coordinates with the pharmacy team daily to ensure any PBM issues are addressed and resolved, accepted into revenue and billed timely.
• Effectively utilize time and resources to meet performance goals.
• Provides exceptional Customer service to internal and external customers.
• Ensures compliance with federal, state, and local governments, third party contracts, and company policies.
• Clearly communicate any billing related issues to all appropriate parties including: Intake, collections, RBL, and manager.
• Monitoring the unbilled-pending invoices queues and communicate to the branch on missing or needed documents or information.
• Maintain current knowledge of departmental and organizational policies.

Schedule: Monday - Friday, 8:30am - 5pm

Qualifications

• 2 years of home infusion billing experience is required.
• High School Diploma or equivalent.
• Knowledge of HCPC coding and medical terminology.
• Experience providing customer service to internal and external customers.
• Must be computer literate.
• Must be dependable. Excellent phone and email communication skills.
• Working knowledge of ICD10, CPT, NCCI; must be familiar with modifier application and standard billing regulations.

Benefits

• Competitive Wages
• 401(k) with a Match
• Referral Bonus
• Paid Time Off
• Great Company Culture
• Annual Merit Based Increases
• No Weekends or Holidays
• Paid Parental Leave Options
• Affordable Medical, Dental, and Vision Insurance Plans
• Company Paid Disability and Basic Life Insurance
• HSA and FSA (including dependent care) Options
• Education Assistance Program