Overview
Continued growth at Maxor has created an opportunity for a Billing Specialist. The collections representative is responsible for tracking all claims that are submitted for payment by analyzing patient accounts to maximize reimbursement. Ensures the use of appropriate collection methods as established by our Maxor Specialty Pharmacies.
Position Location
This is a remote-based position within the Continental US.
Our Company
Founded in 1926, Maxor is a leading, independent pharmacy solutions platform that improves prescription drug affordability and outcomes. Over time, Maxor has built a unique and complementary suite of services and technology offerings that deliver clinical, financial and strategic value to patients, payors and providers across the pharmacy supply chain. Maxor has a proud heritage of growth and innovation earned over the decades. Amarillo, Texas is the legacy headquarters for Maxor, but our talent base is national. We operate pharmacies and other business operation sites across the United States with more than 1200 employees working from 42 states.
Why Maxor?
Pharmacies are essential to healthcare, with nearly 90% of the US population living within 5 miles of one and seeing their pharmacist an average of 12 times a year. Providing a positive patient experience is crucial to ensuring patients adhere to their therapies. At Maxor, we recognize that our employees are our most valuable assets. We actively seek and retain talented professionals who are mission-driven to improve healthcare outcomes for patients. Our employees are essential to their own well-being, finding fulfillment in meaningful work, competitive compensation, diverse and inclusive teams, and limitless career possibilities. With a workforce of 1,000+ and almost a century of pharmacy experience, we offer the stability of a Fortune 500 company and the energy and innovation of a startup. Our expertise and technology support the entire pharmacy ecosystem, but our impact goes beyond pharmacy services. We enable pharmacy care.
Responsibilities
Prepare and submit clean claims to third party insurance carriers, Medicare, Medicaid, copay assistance programs and foundations either electronically or by hard copy billing. This includes primary, secondary, and tertiary claims.
Assist in billing some secondary NCPDP/RX claims including claims secondary to Medicare.
Assists in making adjustments on accounts receivable collections and maintaining the patient financial record including adjustments due to secondary NCPDP/RX claims.
Submit PA request to Texas Medicaid & their managed care plans for supplies.
Follow-up with Medicare and Texas Medicaid on unpaid claims until the claims are resolved.
Appeal Medicare and Texas Medicaid claims when necessary and follow-up until complete.
Process denied/rejected claims by correcting any billing error and resubmitting claims to third party insurance carriers.
Communicate with Pharmacists and other staff to ensure that all necessary information is in place prior to filing claims.
Perform Medicare and Texas Medicaid eligibility checks.
Responsible for calculating Medicare pricing for new referrals, as well as patient responsibility for refills.
Responsible for ensuring Medicare patients meet criteria and we have everything Medicare requires prior to approving an initial dispense and refills. This includes requesting medical documentation when necessary.
Responsible for working various daily, weekly, and monthly reports related to billing functions.
Maintains a good working knowledge for all payer and provider contracts.
Reports financial information to the Director of Reimbursement Services and other appropriate management as needed.
Keep updated on all third party billing requirements and changes for insurance types within their area of responsibility.
Demonstrate knowledge of and supports policies and procedures, operating instructions confidentiality standards, and the code of ethical behavior. Scan CMS-1500’s and supporting documentation on M-drive.
Qualifications
Education:
- High School Diploma or Equivalency
Experience:
- Two years accounts receivable in a medical setting. Some college work in financial or mathematical fields is a plus.
Knowledge, Skills, and Abilities:
- Track all claims that are submitted for payment and monitor the days outstanding for payment reception.
- Notify third party insurance carriers when claims have not been paid within the time frame established by IVSolutions.
- Process billing calls and questions and answers correspondence to patient accounts.
- Help arrange payment options for individual patients with an outstanding balance if payment cannot be made all at once.
- Follow up on unpaid claims until the payment is received or management makes a decision for the action needed for all claims resolutions.
- Process rejections by making accounts patient responsibility and generating a letter of rejection to patient or by correcting any billing error and resubmitting claim to the third party insurance carrier.
- Contact individual patients according to guidelines established by IVSolutions that owe balances for therapy if a payment is not received 30 days after a bill is submitted.
- Notifies all staff members when a patient has an outstanding and past due balance.
- Secure needed medical documentation requested by third party insurances.
- Negotiates pricing with insurance companies with supervisor’s guidance.
- Maintains a good working knowledge for all payor and provider contracts.
- Assist the Reimbursement Department in all claims resolutions.
- Demonstrate knowledge of and supports policies and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
- Maintain regular attendance in accordance with established policies.
- Perform other job-related duties as assigned.
- Promptly report any allegations of impropriety to the Compliance Department.
- Comply with Maxor’s Ethical Business Conduct policy and Maxor’s Compliance Program.
- Remain free from exclusion under the OIG and SAMS Medicare/Medicaid lists.
- Complete required training, as assigned, within the established timeframes.
- Must be able to cope with the mental and emotional stress of the position.
WE OFFER:
A diverse, progressive culture that supports a work from home model, a “dress for your day” attire when working onsite, and a collaborative, team oriented environment. Our industry leading compensation and health benefits include:
- Comprehensive mental health and wellbeing resources
- Nationwide Blue Cross Blue Shield PPO with employee friendly plan design, including $850 individual annual medical deductible, $25 office visit copays, Low biweekly premiums
- Company paid basic life/AD&D, Short-term and Long-term disability insurance
- Rx, dental, vision, short-term disability, and FSA
- Employer-matched 401k Plan
- Industry leading PTO plan
- And MORE!
APPLY TODAY: https://www.maxor.com/careers/
Maxor is an EOE, including disability/vets
