Revenue Cycle Specialist managing ABA billing and claims for Dashi Rivers Autism Care. Ensuring accurate billing and seamless credentialing with a hybrid work environment in Northville, MI.
About the role
- Billing Specialist managing pharmacy and medical claims, rejections, payer communication, and patient billing at Reliance Rx Specialty Pharmacy. Supports deliveries, portals, prior authorizations, and financial assistance coordination.
Responsibilities
- Responsible for billing all claims (pharmacy and medical) and managing rejections to ensure appropriate follow up and delivery promise times are met
- Act as a liaison between patients and insurance companies, and facilitate communication between patients and doctors, medical staff and administrative staff
- Work with payors to resolve any billing issues
- Ensure Reliance Rx is following CMS guidelines per Medicare and Medicaid guidance
- Confirmation of billing accuracy and payor billing/shipping requirements
- Process and set up deliveries to medical offices
- Medical claims billing for both supplies and medications
- Confirm financial aspects of the claims prior to them leaving the facility
- Portal management including refill reminders, processing orders from the portal, and completing patient registrations
- Financial assistance coordination with patients for foundation care, copay assistance, or free medication programs where applicable
- Assist the Patient Care Specialists in workflow and with incoming and outgoing calls, maintaining patient records, filing and documentation duties
- Set up and data entry, financial arrangements and collecting co-payments
- Prior authorization assistance with offices and coordination of benefits
- Promote information sharing and continuous process improvement
- Function in strict accordance with standard, written procedures and guidelines with deviation approved by the supervising pharmacist
Requirements
- High school diploma or GED required
- National Pharmacy Technician Certification (CPhT) preferred
- One (1) year of experience working in a high-volume pharmacy, or equivalent setting, required, or six (6) months as a temporary associate in the Reliance Rx Operations & Compliance department
- Experience working with online claims processing system preferred
- Effective oral and written communication skills and an aptitude for working with other health care professionals
- Ability to lift a minimum of 5 lbs
- Proven examples of displaying the Reliance values: Collaborative, Accessible, Results-Oriented, Empowering, and Supportive
- Immigration or work visa sponsorship will not be provided for this position
Benefits
- first-class perks, benefits and a culture that fosters growth, innovation and collaboration
- associates may be eligible for a scorecard incentive
- full range of benefits
- generous paid time off
- reasonable accommodations for qualified individuals with disabilities and disabled veterans
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