by twochickswithasidehustle | Oct 28, 2024 | Uncategorized
Description
From Intake to Outcomes, CareMetx is dedicated to supporting the patient journey by providing hub services, innovative technology, and decision-making data to pharmaceutical, biotechnology, and medical device innovators.
Job Title: Reimbursement Specialist
POSITION SUMMARY:
Under the general supervision of the operational program leadership, the Reimbursement Specialist is responsible for various reimbursement functions, including but not limited to benefit investigations, prior authorization support, and call triage. The Reimbursement Specialist responds to all provider account inquiries, appropriately documents all provider, payer and client interactions into the CareMetx Connect system and ensures that the necessary data for prior authorization request are obtained.
PRIMARY DUTIES AND RESPONSIBILITIES:
Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program.
Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications.
Completes and submits all necessary insurance forms in a timely manner as required by all third party payors for prior authorizations. Tracks and follow up on prior authorization request.
Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
Maintains frequent phone contact with provider representatives, third party customer service representatives, and pharmacy staff.
Reports any reimbursement trends/delays to supervisor.
Processes any necessary insurance/patient correspondence.
Provides all necessary documentation required to expedite prior authorization request. This includes demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians.
Coordinates with inter-departmental associates as necessary.
Communicates effectively to payors to ensure accurate and timely benefit investigations.
Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action.
Reports all Adverse Events (AE) disclosed in alignment with training and Standard Operational Procedures (SOP)
Typically receives little instruction on day-to-day work, general instructions on new assignments.
Other duties as assigned – Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
Qualifications
EXPERIENCE AND EDUCATIONAL REQUIREMENTS:
- High School, Diploma, or GED required
- Previous 1+ years of experience in a specialty pharmacy, medical insurance, physician’s office, healthcare setting, and/or related experience.
MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:
- Ability to communicate effectively both orally and in writing.
- Ability to build productive internal/external working relationships.
- Strong interpersonal skills.
- Strong negotiating skills.
- Strong organizational skills; attention to detail.
- General knowledge of pharmacy benefits, and medical benefits.
- Global understanding of commercial and government payers preferred.
- Ability to proficiently use Microsoft Excel, Outlook and Word.
- Ability and initiative to work independently or as a team member.
- Ability to problem solve.
- Strong time management skills.
- Customer satisfaction focused.
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to sit.
- The employee must occasionally lift and/or move up to 10 pounds.
Work Environment
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate.
Schedule
- Must be flexible on schedule and hours
- Overtime may be required from time to time
- Must be willing to work weekends if required to meet company demands
CareMetx considers equivalent combinations of experience and education for most jobs. All candidates who believe they possess equivalent experience and education are encouraged to apply. At CareMetx we work hard, we believe in what we do, and we want to be a company that does right by our employees. Our niche industry is an integral player in getting specialty products and devices to the patients who need them by managing reimbursements for those products, identifying alternative funding when insurers do not pay, and providing clinical services. CareMetx is an equal employment opportunity employer. All qualified applicants will receive consideration for employment and will not be discriminated against based on race, color, sex, sexual orientation, gender identity, religion, disability, age, genetic information, veteran status, ancestry, or national or ethnic origin.
Salary Description
$30,490.45 – $38,960.02
by twochickswithasidehustle | Oct 28, 2024 | Uncategorized
About Nabis
Nabis is the #1 Licensed Cannabis Wholesale Platform in the world with the largest portfolio of cannabis brands, supplying hundreds of brands to retailers across California, New York, and Nevada. Our mission is to empower the world to discover cannabis by providing choice, access, and innovation.
We’re at the forefront of this movement and are building an innovative technology-first platform to scale the entirety of the cannabis industry. Through dedication to enhancing efficiency, transparency, and customer satisfaction, Nabis is paving the way for sweeping legalization.
Our team, backed by Y Combinator and from a celebrity roster of tech luminaries and celebrities, including Doordash co-founder Stanley Tang, NFL Hall of Famer Joe Montana, Gmail creator Paul Buchheit, and Twitch cofounder Justin Kan, is scaling the cannabis supply chain with technology and our ultimate goal is to become the largest distributor of cannabis products in the world.
About the Role
The Accounts Receivable Associate is responsible for managing daily accounts receivable processes and credit operations for a diverse range of retailers, ensuring timely collections from delinquent accounts on behalf of leading cannabis brands.
Responsibilities
- Collaborate effectively with the invoicing and operations departments, as well as with retailers and brands.
- Provide real-time delivery support if payment issues arise
- Manage tasks and workflows assigned through Asana and ZenDesk platforms.
- Maintain a portfolio of retailers and provide consistent and detailed updates.
- Coordinate closely with the accounting and invoicing teams to address issues related to retailer credit, discounts, and bounced checks.
- Engage with retailers regarding overdue invoices, swiftly resolving any related issues.
- Streamline communication between multiple parties (internal and external)
- Triage delegated tasks and self-prioritize outreach to account portfolio
- Escalate delinquent account matters appropriately.
- Keep management and brands informed of potential collection issues early in the process.
- Generate weekly reports on credit and accounts receivable data at the account level, and support the accounting team with information necessary for managing allowances for doubtful accounts.
- Identify invoices that are likely uncollectible and communicate effectively with all concerned parties.
- Cultivate and enhance relationships with retailers to facilitate streamlined payment processes.
Requirements:
- Bachelor’s degree in a relevant field or equivalent professional experience.
- 1-3 years of experience in lending, customer service, or collections, preferably within the retail or distribution sectors.
- Experience in B2B sectors preferred
- Proficient understanding of accounts receivable and collections procedures.
- High energy, motivated, and committed with a professional demeanor.
- Exceptional communication skills, both written and verbal.
- Skilled in managing challenging conversations and situations with a high level of judgment, professionalism, and empathy.
- Strong negotiation and problem-solving abilities.
- Highly organized with meticulous attention to detail and excellent record-keeping skills. Ability to create and maintain procedural documentation.
- Thrives in a fast-paced startup environment, adaptable to constant change and comfortable with ambiguity.
- Proficient with Google Suite and Microsoft Office, especially Excel.
- Enthusiastic about the opportunity to work in the cannabis industry.
NABIS IS AN EQUAL OPPORTUNITY EMPLOYER
Nabis is seeking to create a diverse work environment because all teams are stronger with different perspectives and life experiences. We strongly encourage women, people of color, LGBTQIA individuals, people with disabilities, members of ethnic minorities, foreign-born residents, older members of society, and others from minority groups and diverse backgrounds to apply. We do not discriminate on the basis of race, gender, religion, color, national origin, sexual orientation, age, marital status, veteran status, or disability status. All employees and contractors of Nabis are responsible for maintaining a work culture free from discrimination and harassment by treating others with kindness and respect.
by twochickswithasidehustle | Oct 24, 2024 | Uncategorized
At Sevita, we believe that everyone deserves to live well. For more than 50 years, our team members have provided home and community-based health care for adults, children, and their families across the United States. Our extraordinary team offers innovative, quality services and support that lead to growth and new opportunities for the people we serve and for our employees.
Do you have experience in Accounts Receivable/Collections and a desire to work for a company that positively impacts the lives of others? In the AR Collections Specialist role, you will contribute to the company’s commitment to serve others by sending claims to the payer in a timely and accurate manner.
This role is 100% remote and can be performed from anywhere in the US.
Responsibilities:
- Review and work in Denial Workflow (DWF) for tasks with follow-up dates that are set to expire on that day and for tasks without a payer response once past 30 days from billing
- Work credit balances on the aging and overpayment account and follow the credit balance procedure for resolution
- Prepare appeal packet as required by payer, scan and save documentation to be sent, and update DWF with notes and a follow-up date
- Update collection procedures as necessary
- Review and work denials in workflow system, payer portal, and/or clearinghouse portal daily
- Follow-up with Field on updates to items assigned to them that are past follow-up date
- Update DWF with clear concise notes as claims are worked
- Review unapplied cash log for any items that can be applied and work with cash team to resolve
- Complete necessary forms and provide appropriate support for refunds, cash moves, sales adjustments, and transfer of liability
- Ensure internal control compliance with all assigned areas and other audit requirements
- Maintain an effective control environment for the accounting operations
Qualifications:
- High school diploma or equivalent required; Associate or Bachelor’s degree in a finance-related field preferred
- 2-3 years of experience with Medical Collections in a high-volume environment preferred Knowledge of ICD-10 diagnosis codes, CPT medical service codes, UB-04, and HCFA-1500 forms
- Strong understanding of medical collections compliance, Medicare, Medicaid, Medicaid managed care, Commercial, Workers Comp, and Auto-no-fault payer types
- Self-motivated, detail-oriented, and highly organized with the ability to multi-task
- Excellent communication skills, analytical skills, and the ability to collect information from multiple sources
- Effectively use Microsoft Office
Why Join Us?
- Full compensation/benefits package for employees working 30+ hours/week
- 401(k) with company match
- Paid time off and holiday pay
- Complex work adding value to the organization’s mission alongside a great team of coworkers
- Enjoy job security with nationwide career development and advancement opportunities
We have meaningful work for you – come join our team – Apply Today!
Sevita is a leading provider of home and community-based specialized health care. We believe that everyone deserves to live a full, more independent life. We provide people with quality services and individualized supports that lead to growth and independence, regardless of the physical, intellectual, or behavioral challenges they face. We’ve made this our mission for more than 50 years.
Sevita is committed to providing equal opportunities to all employees and applicants for employment. We are committed to creating an inclusive and diverse workplace that values and respects the unique talents, experiences, and perspectives of our employees and the people we serve.
As an equal opportunity employer, we do not discriminate on the basis of race, color, religion, sex, national origin, age, disability, genetic information, sexual orientation, pregnancy, gender identity or any other characteristic protected by law. Explore Location
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