The IV & Biologics Medical Biller & Bio Coordinator/Prior Authorization Specialist provides administrative support in the billing and collections function of the medical revenue cycle process. Prepares new charges, maintains patient records, and is responsible for collecting outstanding accounts receivable. They will also be a part of the bio coordination team to gather insurance authorization for all referred patients.
Essential Functions:
Medical Biller - Job Responsibilities
- Obtain needed and or corrected information by contacting the patient, physician’s office, hospital, next of kin, insurance carrier, etc.
- Verify all patient information uploaded is accurate.
- Maintains the database by entering, updating, and retrieving data, as well as formatting
- Assists in resolution of outstanding accounts receivable problems from past due accounts.
- Assists with credentialing for new sites-of-care
- Responds to inquiries from customers or external collection of resources.
- Places calls and sends messages to those with unresolved issues.
- Understands and maintains all governmental, regulatory and company billing and compliance regulations and policies for payers
- Follows-up with payers, patients, and other appropriate parties to collect open billings in a timely manner
- Identifies and reports to management any payer issues with regards to billing and collections
- Reviews, analyzes, and reconciles Accounts Receivable and discrepancies to provide accurate invoicing and prompt payment
- Performs other duties as assigned
Bio Coordinator/Prior Authorization Specialist – Job Responsibilities
- Obtain new patient referral information from our referring providers or patients on a daily basis
- Verify insurance coverage for the therapy being prescribed from primary, secondary, or tertiary payers
- Confirm patient liability for the prescribed therapy
- Gather and exchange information to gain authorization for therapy requested and re-authorization as necessary, which may include gathering patient-specific clinical data from referral sources
- Enter patient demographic information into the clinical or billing systems and ensure that the patient database is complete
- Communicate with other departments regarding the status of referrals and documentation requests
- Notify patients or referral sources regarding prior authorization status as necessary
- Enroll commercial patients in copay assistance, track and monitor for re-enrollment
- Review benefits for all patients on the schedule in Athena a minimum of 2 days before their appointment date, and attempt to collect from the patient
- Assist with out-of-network claims negotiation requests for the following procedures billed to insurance
- Assist with aging and claim follow up for all claims as directed by the administrative staff
- Performs other duties as assigned
Required Qualifications:
Medical Biller Qualifications
- High level of quality awareness, accuracy, and attention to detail
- Strong communication, organizational, and problem-solving skills
- Sense of urgency and customer-oriented mindset with understanding of Health Insurance Portability and Accountability Act (HIPAA) compliance and Protected Health Information (PHI)
- Ability to work independently, multitask and handle various priorities in a fast-paced environment
Bio Coordinator/Prior Authorization Specialist Qualifications
- Prior experience in a similar role for biologics and infused medicines preferred
- Demonstrated customer-service skills
- Be a person of integrity and character, willing to embrace change and make a positive impact in the lives of patients and co-workers
- Ability to work with staff members at all levels of the organization in a cooperative, team-oriented manner
- Minimum education requirement is a high school diploma or GED
- Proficient in PC windows environment
- Proficient in use of English language both in written and verbal communication
- Must be able to communicate with individuals of varying socioeconomic backgrounds
- Ability to work in various positions (standing, sitting, bending, walking) for extended periods of time during an 8-hour workday
- Ability to remain calm and professional regardless of workload or time constraints
Education and Experience
- At least two years' experience in a medical office setting in billing, accounts receivable, and claim follow up
- Five years’ experience in a healthcare environment, preferably in an infusion center
- A general knowledge of CPT and ICD coding
- ICD-10: 1 year (Preferred)
- High school diploma or equivalent required
Pay: $30.00 - $35.00 per hour
Benefits:
- Health insurance
- Paid time off
Work Location: In person
