Position Overview:
The Medical PA and AR Coordinator is responsible for multiple processes and activities. Tracking, correcting and resubmitting insurance claims are key daily tasks for new and denied claims. Communication skills and customer service are highly regarded as key factors. A variety of administrative skills are necessary to achieve optimum office performance. Proficient knowledge of billing, coding and collections skills are required.  Must possess the ability to verify medical insurance and benefits, collect copayments, deductibles and coinsurance. Work independently without significant supervision.

• Answer phone and greet patients and schedule appointments.
• Submit Prior Authorization for approval and maintain current status for all billable services.
• Submit and track assignments for credentialing and contracting.
• Clear knowledge of navigating insurance portals to submit and track the status of a claim, upload records and file appeals as needed.
• Ensure that all items that were billed have been paid, investigate unpaid items and resubmit for payment.
• Demonstrate clear knowledge of reading EOBs and identifying outstanding line billing explanations
• Print AR report and EOBs for all insurance carriers weekly to assess status of claims, post payments and establish and correct denied claims
• Analyze denied claims, take necessary action with patients and insurance carriers to submit additional information as needed, and refile denied claims with insurance carriers.
• Maintain Medical Director files to ensure compliance and complete record keeping.
• Maintain patient notes and Medication Administration Records following each infusion.
• Collect outstanding amounts from patients as well as amounts due as patients receive treatment.
• Provide monthly AR reports and meet to review progress.
• Mail patient statements and collection letters.

Plus – may perform other duties as assigned.

Key Interactions:

• Internal: Pharmacy Operations
• External: Insurance Companies, Credentialing officials

Education:

• Required: High School Diploma
• Preferred: Associate’s degree or equivalent in related area preferred

Experience:

• 5+ years of A/R Medical Billing experience including Claims status, claims appeals/reconsiderations, charge entry, payment entry and AR follow-up

Technical / Specialized Knowledge, Skills Abilities:

• Knowledge of requirements, codes and procedures necessary to achieve a positive result from insurance.
• Familiar with Insurance HMO, PPO, Medicare and Medi-cal
• Proven basic computer skills with MS Outlook, Word, Excel and computer based medical systems.
• Understanding of HIPAA regulations.
• Knowledge of medical terminology and coding.
• Ability to communicate effectively communicate verbally and written.
• Ability to prioritize and multi-task.

Behavioral Competencies:

• Planning/organizing—the individual prioritizes and plans work activities, uses time efficiently and develops realistic action plans.
• Communication—proactive communication with supervisor, physician, pharmacist, and others making them aware of challenges, concerns, and or questions.
• Attitude – they should lead by example in customer service, teamwork and expectations, helping out wherever needed.
• Customer-service - ensures that the needs of both our internal and external customers are met.
• Reliable – is seen as a “go to” person and can be trusted to do things timely, accurately and efficiently.
• Knowledgeable – in areas of medical terminology, clinical procedures, medical billing and coding and general clinical pharmacy practices; as well as medical legal, revenue cycle and health services related administrative processes

Working Conditions:

• Standard office/infusion center environment.
• Physical Effort: Occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; talk or hear. The employee must occasionally lift or move office products and supplies, up to 20 pounds
• Full-time position with standard business hours; flexibility to work additional hours during peak periods is expected.

Equal Opportunity Employer:
We are an equal opportunity employer committed to diversity and inclusion. We celebrate diversity and are dedicated to fostering an inclusive environment for all employees.