Reimbursement Counselor

Kelly Services is currently recruiting for Document Management Specialists for our client, a leading pharmacy benefits management company in Frisco, TX. This is a 3 month temp-to-hire opportunity and pays $17.00 per hour.

Job Description:

Responsible for various reimbursement functions, including but not limited to accurate and timely claim submission, claim status, collection activity, appeals, payment posting, and/or refunds, until accounts receivable issues are properly resolved.

Duties and Responsibilities:

• Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program.
• Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications and electronic claims to process in a timely manner as required by all third party payers.
• Researches and resolves any electronic claim denials and any claim denials or underpayment of claims. Reports any reimbursement trends/delays to supervisor
• Effectively utilizes various means for collections, including but not limited to phone, fax, mail, and online methods.
• Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers.
• Processes any necessary insurance/patient correspondence.to expedite payments; including demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians.
• Coordinates with inter-departmental associates to obtain appropriate medical records as they relate to the reimbursement process.
• High level of confidentiality regarding patient account status and the financial affairs.
• Communicates effectively to payers and/or claims clearinghouse to ensure accurate and timely electronically filed claims.
• Strong problem and analytical skills and exercises judgment within defined standard operating procedures to determine appropriate action.

Skills and Qualifications:

• High School Diploma or Equivalent
• Excellent customer service and call center experience required
• Ability to communicate effectively both orally and in writing.
• Ability to build productive internal/external working relationships.
• Strong interpersonal, strong negotiating and mathematical skills.
• Strong organizational skills with attention to detail.
• Must have general knowledge of accounting principles, pharmacy operations, and medical claims.
• General knowledge of HCPCS, CPT, ICD-9 and ICD-10 coding preferred.
• Global understanding of commercial and government payers preferred.
• Must be proficient with Microsoft Excel, Outlook and Word.

Term of Assignment:

Why Kelly?

As a Kelly Services candidate you will have access to numerous perks, including:

Exposure to a variety of career opportunities as a result of our expansive network of client companies 

Career guides, information and tools to help you successfully position yourself throughout every stage of your career

Access to more than 3,000 online training courses through our Kelly Learning Center

Group-rate insurance options available immediately upon hire*

Weekly pay and service bonus plans