Reimbursement Specialist

Company Name: Kroger Specialty Pharmacy
Position Type: Employee
FLSA Status: Non-Exempt

Position Summary

Perform duties to process medical billing and PBM and medical collections with focus on accuracy, timeliness and adherence to process, to reduce denial rate, DSO, and bad debt. Recognize additional revenue opportunities, and improve in collection rates, while working within the limits of standard or accepted practice. Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion, and safety.

Essential Job FunctionsReview patient files for completeness and accuracy, identify and audit claims, ensure all revenue opportunities are included, and complete and submit billing, primary and secondary, to payers for reimbursement, via paper bills and clearing house submittalsReview documents received including Explanations of Benefits (EOBs), Remittance Advices (RAs) and other documents indicating denials or claims acceptanceIdentify reasons for denials, take required corrective action, and take ownership of claims through to timely, successful collectionAnalyze denials, identify trends and recommend process improvement opportunities that will result in DSO reduction, superior collection rate and intervals, reduce bad debt, and simplified processes that are responsive to the requirements of specific payersReview claims with outstanding balances and identify actions to successfully collect revenuesFollow up with insurers and patients to collect outstanding balances in an environment of world-class customer service focused on building enduring customer and business relationships; utilize Payer Portals via the internet for claim dispositionDocument case activity, communications and correspondence in computer system to ensure completeness and accuracy of account activity and actions taken to resolve outstanding claims issues; schedule follow-ups in required intervalsContribute medical billing expertise to the design of training and knowledge transfer programs, materials, policies and procedures to improve the efficiency and effectiveness of the Revenue Cycle Management teamAssist with the processing online adjudication of collection issues and nurse billing as assignedPerform or assist with any operations, as required to maintain workflow and to meet schedules and quality requirementsParticipate in any variety of meetings and work groups to integrate activities, communicate issues, obtain approvals, resolve problems and maintain specified level of knowledge pertaining to new developments, requirements, and policiesPerform other related duties as assignedMust be able to perform the essential job functions of this position with or without reasonable accommodation

Minimum Position Qualifications High School Diploma or GEDAny experience in medical billing or collectionsSuperior communications skills; listening, speaking, understanding, and writing English while influencing patients, care givers, payer representatives and others, answering questions and advancing reimbursement and collection effortsProven understanding of processes, systems and techniques to ensure successful billing and collection working with all payer typesProven ability to identify gaps and problems from review of documentation, determine lasting solutions, make effective decisions, and take necessary corrective action

Desired Previous Experience/Education

Coding Course Certification2 years of medical billing and/or collections experienceSome jurisdictions may require the ability to be fluent in English and Spanish

Education Level: High School Diploma/ GED Required
Required Certifications/Licenses: None
Position Type: Full-Time
Shift(s): [[mfield4]]
Regions: West

States: California
Keywords:

Jobs at Kroger: At Kroger, we hire people who have a passion for helping others and who want to build a relationship with our Customers. No matter what stage of your career, you can build your future at Kroger. We look for people who want more, aspire to be more and work hard to achieve their goals. Our focus on keeping the Customer first is what makes us successful. We offer many opportunities not only in our stores, but in Manufacturing, Logistics, Marketing, Finance, Human Resources, and many other fields.

Company Overview: Kroger Family of Companies employs nearly half a million associates who serve over 11 million customers daily through a seamless shopping experience under a variety of banner names. At The Kroger Co., we are Fresh for Everyone™ and dedicated to our Purpose: To Feed the Human Spirit®. We are committed to creating #ZeroHungerZeroWaste communities by 2025. Careers with The Kroger Co. and our family of companies offer competitive wages, flexible schedules, benefits and room for advancement.

Posting Notes: CA || Garden Grove || 7373 Lincoln Way || 92841 || Kroger Specialty Pharmacy || None || Call Center; Specialty Infusion; Specialty Pharmacy || Employee || Non-Exempt || Full-Time || None