Patient Assistance Specialist - Outpatient - 138961

The Patient Assistance Specialist is responsible for the full range of third party and patient billing duties. Extensive knowledge of medical insurance and State and Federal rules and regulations related to billing Insurance Claims. Knowledge in self-pay collections and mandated charity laws. Knowledge of medical/surgical terminology. Knowledge of accounting and cash handling principles and various billing documents and claim forms. Responsible to work system generated claims, edits, attaches records, operative reports and all system reports. Responds to billing inquiries from patients, insurance companies and departments. Identifies and resolves issues regarding account adjustments, rebilling insurance, and/or collecting from patients as appropriate. Job is to be performed at the EXPERT level. Other related duties as assigned.

• Three (3) years of medical and pharmacy claims billing, denial mitigation and appeals.

• Familiar with reading medical and pharmacy records in order to submit records to support medical necessity based on diagnosis and services rendered.

• Clear understanding or know how to properly obtain the different types of payer information timely and how to prioritize workload based on the payer specific info.

• Capable and comfortable with verifying patient coverage/insurance verification and adjudication via a payer portal, Epic system or by phone.

• Extensive knowledge of pharmacy and medical insurance billing/processes, billing documents, claim forms, HIPAA, PHI, and a thorough understanding of state and federal rules for billing and appealing pharmacy and medical claims.

• Knowledge of eligibility criteria of pharmaceutical companies and foundations.

• Strong proficiency with MS Office Products (Mail, Excel and Word).

• Detail oriented, with organizational skills and the ability to manage time efficiently, prioritize tasks, and complete assignments consistently on schedule.

• Basic communications skills, with the ability to interpret and present clinical financial information clearly and concisely.

• Experience in Social Determinants of Health to advocate for patients with special needs.

• Pharmacy Financial Assistance experience.

• Outpatient Pharmacy general experience.

• Must be able to work various hours and locations based on business needs.

• Employment is subject to a criminal background check and pre-employment physical.