Title: Billing Coordinator

Location: Long Beach

Department: Ambulatory Pharmacy Revenue Cycle

Status: Full Time

Shift: Days

Pay Range*: $25.71/hr - $37.28/hr

At MemorialCare Health System, we believe in providing extraordinary healthcare to our communities and an exceptional working environment for our employees. Memorial Care stands for excellence in Healthcare. Across our family of medical centers, we support each one of our bright, talented employees in reaching the highest levels of professional development, contribution, collaboration and accountability. Whatever your role and whatever expertise you bring, we are dedicated to helping you achieve your full potential in an environment of respect, innovation and teamwork.

Position Summary

The Senior Billing Coordinator (SBC) for Infusion Care Pharmacies has responsibility for obtaining insurance authorization and reauthorization for service, verifying patient eligibility, reviewing billing for products and services, and insuring the maximum allowable payment for the services rendered. The SBC is also responsible for working with the clinical staff in contract negotiations with insurance companies and medical groups. The SBC also collects data and reports on the financial viability of the infusion pharmacy operations to the Billing Manager, Pharmacy Manager and Pharmacy Director. The SBC will be responsible for training staff and monitoring intake/authorization staff effectiveness.

Essential Functions and Responsibilities of the Job

1.Receives inbound faxes and physician orders for home infusion therapy. Handles inbound calls from Case Managers and Pharmacy regarding Intake orders. Prioritizes orders by importance based on discharge dates/times or urgency. Enters all patient demographics and physician order information accurately into patient account. Drug/formula calculations are done accurately. Asks for assistance from Pharmacy as needed.

2.Verifies eligibility with insurances, and documents findings in patient account. Patient paperwork showing responsibility and government required documents are prepared and given to patients timely. Reports patients without eligibility to Manager.

3.Obtains authorization for patient care. Follows up daily on pending authorizations to assure claim drops for billing as soon as possible. Reports any delays in authorizations to Managers.

4.Works in concert with other Intake Representatives to assure all work is current at the end of each work day.

5.Works with clinical staff and management to make recommendations for contract negotiations with insurance companies and medical groups. Identifies areas for greater reimbursement.

6.Performs other duties as assigned.

*Placement in the pay range is based on multiple factors including, but not limited to, relevant years of experience and qualifications. In addition to base pay, there may be additional compensation available for this role, including but not limited to, shift differentials, extra shift incentives, and bonus opportunities. Health and wellness is our passion at MemorialCare—that includes taking good care of employees and their dependents. We offer high quality health insurance plan options, so you can select the best choice for your family. And there’s more...Check out our MemorialCare Benefits for more information about our Benefits and Rewards.

Qualifications - External

Experience

·         5+ years experience in with familiarity in insurance billings and collections, knowledge of basic bookkeeping practices.

·         PC proficiency (Word, Excel, MS Office) and knowledge of generally accepted accounting practices and principals.

·         Able to communicate effectively and interact positively and constructively with patients, insurance company representatives, coworkers and other health care professionals. Follows all applicable laws, regulations, company rules and policies. Follows directions from pharmacists, Managers and Director.

Education

·         High School Diploma. College degree preferred.