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Reference # : 19-214439 Title : Pharmacy/Infusion Billing Follow Up
Location : Portland, OR
Position Type : Right to Hire
Experience Level : Start Date / End Date : 04/01/2019 / 09/30/2019  
Description
Job Order #19-02862
Job Title: Insurance Billing Follow-up (Pharmacy/Infusion)
Location: 4400 NE Halsey St. Portland, OR 97213
Duration: Contract-to-hire

MISSION, CORE VALUES AND VISION:
 
Mission: As people of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service.
Core Values: As a member of the Providence team, you will work in a mission-driven environment that encourages diversity and personal growth and fosters our core values of Respect, Compassion, Justice, Excellence, and Stewardship.
Vision: As people of Providence, we will provide a connected experience of care built on a foundation of clinical excellence. 
 
JOB DESCRIPTION:
Position purpose is the timely and accurate collection of payment from insurance carriers, agencies, and others for equipment and services provided by Home Services. Performs all duties in manner that promotes team concept and reflects the Providence Health system mission and philosophy. Home Services- DME provides durable medical equipment and supplies, to patients who do not require hospitalization but need these services to optimize their safety, comfort, and quality of life while at home. Performs all duties in manner that promotes team concept and reflects the Providence Health system mission and philosophy. 
 
KEY RELATIONSHIPS: Reports to the Home Services Billing Supervisor. 
 
RESPONSIBILITIES:
  • Conducts thorough follow-up on denied or partially paid claims to ensure that reprocessing occurs within timely billing limits and full reimbursement is made. Notates in billing system follow-up activity in account notes future reference.
  • Respond to incoming calls from patients, guarantors, insurance companies or other sources to assist with questions or concerns on accounts.
  • Communicates effectively with patients, payers and ancillary departments to independently resolve billing issues.
  • Establishes expertise in the line of business (DME) and with the payers (government, commercial, managed care) assigned.
  • Identifies process breakdowns as they occur and remedies them or escalates issue to higher authority to resolve.
  • Educates themselves continually on payer requirement changes. Maintain up-to-date reference materials to ensure billings meet regulatory requirements.
  • Utilize solid judgment and adhere to all policies ensuring the protection of confidential information related to patient demographics, medical information, diagnosis codes, etc. according to both internal and Federal HIPAA regulations and guidelines.
  • Seeks out relevant training. Seeks out guidance when uncertain of procedure or policy.
  • Performs other related duties as requested by Supervisor or Lead. 
 
QUALIFICATIONS:
The qualifications for the position are the minimum requirements needed to be successful in the position. The level of experience and expertise for the job is determined by the current amount of expertise in the unit/department. If training or experience is not required but would be desirable, it is listed as preferred however, persons without preferred background will be considered in the hiring process.
 
  • Education, Training & Experience  (includes licenses or certifications): High school graduate or GED equivalent required. College level courses in medical front office/medical billing preferred.
  • Minimum two years health care account management experience. Experience in DME (Durable Medical Equipment) billing strongly preferred. 
  • Excellent interpersonal communication and public relations skills required.
  • Excellent writing skills required.
  • Knowledge of medical terminology, ICD-9 coding, HCFA 1500 required.
  • Independent thinking and decision-making skills.
  • In depth knowledge of regional managed care, Medicare, Medicaid programs.
  • Ability to organize and manage time effectively to optimize productivity.
  • Ability to work in a fast-paced, high volume environment.
  • Ability to maintain flexibility in meeting department as well as personal workload demands