Here at CiNQ Recruitment, we believe in finding the right fit, for you and our clients. Whether you seek long-term employment solutions for your business or your next career move, we understand the importance of individual and business needs. With over 30 years of successful staffing and recruiting experience, we excel at providing passive candidates with the right skills and cultural fit for specialized positions. Here is the opportunity to work with an exciting pharmaceutical company

Position Summary:
Oversee all reimbursement activities for specified business unit(s), with particular focus on accurate and timely processing of Pharmacy claims through Medical, Medicare B, Medicaid and PBM benefits, PR verification, billing, and collections processes. Obtain accurate benefits and authorizations for payers. Supervise team to successfully meet the critical challenges of timely, successful revenue collection from payers, coupled with high-class customer service to build patient loyalty. 

Essential Functions:  

• Ensure timely and accurate billing for Major Medical or Medicare claims, and contact payers for AR collections follow-up on outstanding claims, including electronically adjudicated claims.  
 
• Monitor productivity and quality of performance of direct team members through tracking and monitoring key performance metrics and targets related to financial, quality and activity-based factors.  Perform follow-up checks to verify integrity of cash applications and reconciliation.  
 
• Identify, analyze, and recommend performance enhancement initiatives.  
 
• Provide feedback and work with intake team to address and/or prevent upfront issues that might result in delayed payment, bad debt risk, or inefficient processing. 
 
• Initiate processes to provide regular communication with team members and other functional teams to review metrics, objectives and performance, and to foster a high-performance team environment. Focus on root cause analyses, permanent problem solving, and continuous improvement.  
 
• Assist with month-end close process, to ensure all charges, payments and other required tasks have been completed accurately and timely. 
 
• Maintain current awareness of key industry information and evolution. Act as technical guide for the site, providing insights and resources to ensure team performance. Create a means for knowledge transfer that enhances site quality and efficiency. • Partner with payors to understand requirements and ensure that efficiency and compliance are built into billing processes. Support and supervise payor or finance requested audits. Interview, select, hire, train and assign associates.   
 
• Develop and communicate performance metrics to assess the effectiveness of associates, both as a department and individually. Evaluate performance and provide direction, mentoring, coaching and cross training to associates. Identify and provide associate training requirements. 
 
• Some jurisdictions may be required to maintain current updates on Inmediata and ensure that team follows necessary protocols for payment. 

 Other Duties:

• Perform or assist with any operations, as required to maintain workflow to meet schedules and quality requirements.  
 
• Participate 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 policies. 
 
• Perform other duties as assigned. 

 Competency:

• Effective problem solving skills with intake experience, including eligibility of benefits, claims processing, cash posting and reconciliation knowledge.  
 
• Knowledge of accounting procedures, healthcare terminology and government and insurance carrier billing and collections procedures, and strong knowledge of prior authorization and appeals process. 
 
• Team building skills, and the ability to influence and lead, teach, train, counsel and coach to accomplish organizational goals. 
 
• Some jurisdictions may be required to be fluent in Spanish and English (verbal and written) 

Education/Experience Requirements:
 

• Required:
  • Bilingual in Spanish
  • Associate’s Degree in Medical Billing or similar discipline – or equivalent work experience
  • Minimum 3 years’ experience in medial including billing and collections across multiple types of payors; with at least 2 years’ proven leadership experience.
  • Minimum 3 years’ Benefit Eligibility, Obtaining Authorizations, Medical Billing, Accounts Receivable and Collections experience.
  • Experience supervising a team
  • Comfortable in a call center – has urgency, fast paced
  • Heavy AR knowledge and comfortable doing patient collections. Must be willing to jump in and help the team.

All your information will be kept confidential according to EEO guidelines.

Pay Rate: $22-$26/HR