Claims Specialist

Company: KabaFusion
Location: Cerritos
Posted on: August 7, 2022

Job Description:

KabaFusion is a home infusion company with exceptional employees!

KabaFusion is a home infusion company with a national network of pharmacist owned pharmacies with the ability to service 40+ states. While we are known for our expertise in IVIg and SCIg, we also provide acute infusion and nutritional therapies.

Our success is the result of teamwork from our dedicated staff who truly believe in putting the "care" back in healthcare. A career at KabaFusion means joining a team that lives by its values and empowers team members to make a difference!

What we offer:

Competitive compensation

Benefits start on your 1 st day of employment

401K w/ 4% Match - no waiting or vesting period

PTO / Floating Holidays / Paid Holidays

Company Paid Life Insurance

3 Employee Assistance Programs (EAP)

Emerging Leaders Training Program

Perks--- includes discounts on travel, cell phone, clothing, and more---

Employee Referral Program

JOB SUMMARY:
The Claims Specialist is responsible for the accurate resubmission of unpaid claims and the collection of payment of those claims according to the payor's guidelines.

DUTIES & RESPONSIBILITIES:

Analyze and rectify claims issues with payers by timely follow up of claim status/payment.

Reviews and assures claims are processed and paid in full according to contractual agreements.

Ensures revenue is booked according to appropriate contract allowable.

Communicates with branches and other departments to assure resolution of reimbursement issues.

Communicates and addresses reimbursement issues with management for resolution in a timely manner.

Handles collections calls promptly with professionalism to payers and/or patients.

Must be able to prioritize, multi-task, meet goals and deadlines.

Protects patient health information by following regulations for HIPAA compliance.

Ensures daily productivity is met and monthly and monthly closing goals are met.

Meet and Maintain Cash Collection Goals and Metrics on a daily and monthly basis.

Timely Review of Remittance Advice/Correspondence; take appropriate steps to appeal non-payment of claims.

Utilize payer websites as resources to manage claim status and resolution.

Report to Manager on any reimbursement issues resulting in non-payment.

PREFERRED SKILLS & EXPERIENCE:

Strong understanding of insurance terms, medical terminology, pricing methodologies for commercial and government billing requirements.

Knowledge and understanding of HCPC and CPT codes

High School Diploma or equivalent education.

Minimum 1 year of experience collecting from payors (health plans, medical groups and pharmacy benefits managers)

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Keywords: KabaFusion, Cerritos , Claims Specialist, Other , Cerritos, California