Job Title 

Billing Specialist

Location

Remote/Nationwide, USA

Employee Type

Employee

Working Hours Per Week

40

Summary

Under the general supervision of Management, the Billing Specialist is responsible for assisting the billing team in ensuring accurate billing, timely submission of electronic and/or paper claims, solving for unique billing requirements, resolving claims due to billing requirements, and documenting related account activities.  Ensure that all billing is done promptly and meets month-end expectations.

Essential Duties and Responsibilities

include the following. Other duties may be assigned, as necessary.

• Perform pre-bill review to ensure that authorization is documented where necessary.
• Ensure that coding on claims follows payer guidance. 
• Ensure accurate billed and expected charges do not exceed usual and customary or contractual pricing where indicated.
• Create and submit primary and secondary pharmacy and medical claims promptly.
• Reviewing and identifying claims pricing discrepancies based on updates/changes to fee schedules.
• Communicate any billing-related issues to all appropriate parties including Intake, Collections, and Manager.
• Ensure coding to the highest level of specificity and for maximum reimbursement by third-party payers.
• Maintain current knowledge of departmental and organizational policies.
• Support billing staff in training and ongoing education when required

• Consistently represents the company in a professional manner.
• Maintains effective working relationships and cooperates with all personnel in the Company.
• Adheres to the Company’s compliance requirements as stated in the policy and procedure manual and all other related policies.
• Performs other duties and responsibilities as assigned

Qualification 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 accommodation may be made to enable individuals with disabilities to perform essential functions.

• Provide the highest level of professionalism, responsiveness, and communication.
• Must possess the ability to multi-task and frequently change direction.
• Proficient in the use of a computer and other devices.

Education and/or Experience

• High school diploma or GED
• Ability to work independently and within a multidisciplinary team. 
• Basic math, bookkeeping, and accounting skills
• 1-3 years of experience in medical billing.
• Understanding of industry-specific policies, such as HIPAA regulations for healthcare

Physical Demands

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 essential functions.

While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Comments

This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.

NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.

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CSI Pharmacy is an Equal Opportunity Employer