Authorization Specialist - Buy and Bill Pharmacy - Medical Billing

About the role

Crossroads Treatment Centers is a family of professionals dedicated to providing the most accessible, highest quality, evidence-based medication assisted treatment (MAT) options to combat the growing opioid epidemic and helping people with opioid use disorder start their path to recovery. Our clinics are all outpatient and office-based, with locations in Georgia, Kentucky, New Jersey, North and South Carolina, Pennsylvania, Tennessee, Texas, and Virginia.

Responsibilities

• Perform all duties and responsibilities in accordance with local, state, and federal regulations and company policies.
• Utilize and apply industry knowledge to resolve new and aged accounts receivables by working various account types, including but not limited to professional claims, governmental and/or non-governmental claims, denied claims, aged accounts, high priority accounts, high dollar accounts, reimbursements, and credits.
• Leverage available resources and systems (both internal and external) to analyze patient accounting information and take appropriate action for payment resolutions; document all activity in accordance with organizational and client policies.
• Communicate professionally (in all forms) with payer resources, including websites/payer portals, email, telephone, and customer service departments.
• Maintain quality and productivity results at a level that meets departmental standards as measured by a daily/weekly/monthly average.
• Verify patient benefits and eligibility for buy and bill drugs.
• Obtain authorization for buy and bill drugs as required by the various payors.
• Submit claims to insurance companies for buy and bill drug administration and related services.
• Track claim status and follow up on denials or incomplete/pending claims.
• Apply on behalf of patients for co-pay assistance programs as applicable.
• Interpret payer clinical guidelines and identify contract variances affecting reimbursement.
• Demonstrate clear proficiency in third-party billing requirements to include federal, state, and commercial/managed care payers.
• Interpret claim scrubber edits/rejections and take appropriate action necessary to resolve issues.
• Seek resolution to problematic accounts and payment discrepancies.
• Prepare appeal letters for technical denials by accessing specific payer appeal forms, submitting appropriate medical documentation, and tracking appeal resolution.
• Other duties as assigned.

Requirements

• At least 2-3 years of accounts receivable experience in a physician office setting.
• Previous Buy and Bill experience preferred.
• General knowledge of HCPCS, CPT-4, and ICD-10 coding and/or medical terminology.
• Familiar with multiple payer requirements and regulations for claims processing.
• High School Diploma or GED.

Benefits

• Medical, Dental, and Vision Insurance.
• Paid Time Off (PTO).
• Variety of 401K options including a match program with no vesting period.
• Annual Continuing Education Allowance (in related field).
• Life Insurance.
• Short/Long Term Disability.
• Paid maternity/paternity leave.
• Mental Health Day.
• Calm subscription for all employees.
• Mileage reimbursement at the current IRS rate (if applicable).
• Community events that promote belonging and education, including cookouts, fairs related to addiction treatment and outreach, parades, addiction awareness for schools, and holiday events.

Have a daily impact on many lives and the opportunity to save lives every day. Excellent training is provided if you are new to this field.