Reimbursement Specialist Garnet Valley, Pennsylvania Overland Park, Kansas, Uni

Location

Garnet Valley, Pennsylvania;
Overland Park, Kansas;
Remote

Bio Matrix is a nationwide, independently‑owned infusion pharmacy with decades of experience supporting patients on specialty medication.

We treat our patients like family and help them quickly start therapy. We work closely with patients, their families, and healthcare providers throughout the patient journey, focusing on optimal clinical outcomes.

At Bio Matrix we commit to a welcoming space where everyone’s contributions are acknowledged and celebrated. We aim to attract, develop, engage, and retain talented individuals from diverse backgrounds and viewpoints.

Up to $27.00 per hour based upon experience.

8:30 am – 5:00 pm CST or EST on site in Overland Park, KS or Garnet Valley, PA, or Remote. Work location may change per business needs.

The Reimbursement Specialist is responsible for accurate and timely billing and reimbursement of claims.

• High School Diploma or GED required
• Minimum of two (2) years of medical insurance experience required
• Basic computer and internet skills (e.g. Microsoft Office)
• Strong customer service skills, focus and dedication.
• Commitment to excellent customer service and professionalism to resolve complex payer coverage issues

• Minimum of two (2) years of home infusion experience preferred
• Prior experience with CPR+ and/or Care Tend preferred
• Certified Pharmacy Technician/License preferred, but not required

• Submits accurate claims to primary and secondary insurers and resubmits accurate corrected and rejected claims in a timely manner.
• Acquires necessary authorizations and current eligibility information from insurance company for the dispense prior to release of delivery; communicates findings with pharmacy prior to delivery; documents notes in system.
• Maintains patient files with pertinent information required by insurance companies (CMN, rxs, medical records, etc.).
• Prior to submitting claims, confirms that orders have been delivered verifying date of delivery.
• Invoices patients for patient responsibility amounts (co-pay, deductible, out-of-pocket, etc.).
• Communicates with field staff as needed (new referrals, signed tickets).
• Responsible for billing audits both internally and externally.

• Tracks each claim on a weekly basis; maintains A-R Manager report in Excel and updates each outstanding claim with a status detail note, includes insurance company’s reference number; submits report to the Director of Revenue Cycle Management; updates the claim’s billing note in CPR+ with the status detail note.
• Predicts cash flow from claim’s progress through insurance system.
• Maintains documents showing proof of communique with insurance companies, providers, etc. (i.e. email printouts, fax confirmations, Fed Ex tracking).
• Tracks incoming checks for receipt; if issued to patient, communicates with patient or RCC to collect monies.
• Responds to insurance requests in a timely manner (medical records, rxs, CMNs, etc.)
• Makes bank deposit and maintains accurate monthly deposit report, as needed.

• Verifies new patient referral information with insurance company, reports findings to Director of Revenue Cycle Management via insurance verification form
• Completes insurance company contracts and/or necessary forms to maintain or become a provider.
• Reports unusual events or trends related to claims or insurance industry to Director of Revenue Cycle Management.
• Assists in insurance audits by providing all necessary billing paperwork in a timely manner.
• Proactively improves understanding of bleeding disorders, products and treatments; stays current on legislative changes and insurance coverages, and is capable of disseminating this information to employees, patients and others within the bleeding disorder community.
• Participation in QMC Quarterly Meetings, as needed.
• Participates in orientation, education, training programs, CE’s, literature reviews and other materials, as assigned.
• Completes all…