Soleo Health is seeking a Billing Specialist to work Remotely (USA). Join us in Simplifying Complex Care! Specialty Pharmacy or Infusion experience required.
Soleo Health Perks:
401(k) with a match
No Weekends or Holidays!
Affordable Medical, Dental, & Vision Insurance Plans
Company Paid Disability & Basic Life Insurance
HSA & FSA (including dependent care) options
Paid Time Off
Education Assistant Program
Great Company Culture!
The Billing Specialist will primarily be responsible for insurance and self-pay billing, excluding Medicare. This role is also responsible for submitting electronic and paper claims. Follows up with clearing house vendors on accepted and working rejections. Responsibilities include:
Preparation of accurate medical claims based on contracted agreements for services to various payers (e.g. Commercial Payers, Government Payers, Employer/ Institutional Payers).
Reviewing and identifying claims pricing discrepancies based on updates/changes to fee schedules.
Creates and submits secondary electronic pharmacy and medical claims in a timely manner.
Billing of manufacturer copays, which includes entering the necessary information into portal or billing via paper at time of initial billing.
Monitors billing requirements pursuant to contracts with third party payers or government programs.
Answer insurance/billing questions from branch staff and help educate.
Review information from electronic medical records in patient account (IE: auth, benefit verification, orders, accounts receivable, etc.) to ensure preparation and submission of clean claims.
Perform routine revenue review of claims billed within the current month.
Answering incoming calls and triage if necessary.
Create claim batches and process them via electronic submission.
Manually process any claims that are not eligible for electronic billing. Identify any claims that need attention, make corrections, and resubmit.
Ensure coding to the highest level of specificity and for maximum reimbursement by third party payers.
Daily review and follow up of unbilled delivery tickets in billing review and ready to bill queues.
Accurately notate patient accounts to reflect all actions made including marginal, split claim notes, missing COGS, etc.
Coordinates with the pharmacy team daily to ensure any PBM issues are addressed and resolved, accepted into revenue and billed timely
Effectively utilize time and resources to meet performance goals.
Provides exceptional Customer service to internal and external customers.
Ensures compliance with federal, state, and local governments, third party contracts, and company policies.
Clearly communicate any billing related issues to all appropriate parties including: Intake, collections, RBL, and manager.
Monitoring the unbilled-pending invoices queues and communicate to the branch on missing or needed documents or information.
Maintain current knowledge of departmental and organizational policies.
3+ years’ experience in medical billing
Home infusion or specialty pharmacy experience required
Knowledge of HCPC coding and medical terminology
Experience providing customer service to internal and external customers
Must be dependable. Excellent phone and email communication skills
Working knowledge of ICD10, CPT, NCCI; must be familiar with modifier application and standard billing regulations
The ideal candidate will have experience with infusion and specialty pharmacy billing
High School Diploma or equivalent
About Us: Soleo Health is an innovative national provider of complex specialty pharmacy and infusion services, administered in the home or at alternate sites of care. Our goal is to attract and retain the best and brightest as our employees are our greatest asset. Experience the Soleo Health Difference!
Soleo’s Core Values:
Improve patients’ lives every day
Be passionate in everything you do
Encourage unlimited ideas and creative thinking
Make decisions as if you own the company
Do the right thing
Soleo Health is committed to diversity, equity, and inclusion. We recognize that establishing and maintaining a diverse, equitable, and inclusive workplace is the foundation of business success and innovation. We are dedicated to hiring diverse talent and to ensuring that everyone is treated with respect and provided an equal opportunity to thrive. Our commitment to these values is evidenced by our diverse executive team, policies, and workplace culture.
Soleo Health is an Equal Opportunity Employer, celebrating diversity and committed to creating an inclusive environment for all employees. Soleo Health does not discriminate in employment on the basis of race, color, religion, sex, pregnancy, gender identity, national origin, political affiliation, sexual orientation, marital status, disability, genetic information, age, membership in an organization, parental status, military service or other non-merit factor.
Keywords: Billing rep, medical billing, coding, reimbursement specialist
$21 – $24 per hour