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About AmeriPharma
AmeriPharma is a rapidly growing healthcare company where you will have the opportunity to contribute to our joint success on a daily basis. We value new ideas, creativity, and productivity. We like people who are passionate about their roles and people who like to grow and change as the company evolves.
AmeriPharma’s Benefits
* Full benefits package including medical, dental, vision, life that fits your lifestyle and goals
* Great pay and general compensation structures
* Employee assistance program to assist with mental health, legal questions, financial counseling etc.
* Comprehensive PTO and sick leave options
* 401k program
* Plenty of opportunities for growth and advancement
* Company sponsored outings and team-building events
* Casual Fridays
Job Summary
The Lead Payment Recovery Specialist (LPRS) is responsible for managing the Appeals, Refunds, and Reconciliation Process related to patient refunds, offsets, and recoupments. The LPRS will handle communications with government health plans, commercial medical plans, and other entities that reimburse Ameripharma for drugs, services, and supplies provided to their members.
Schedule Details
* Location: Laguna Hills, CA
* Hours: Monday - Friday, 8:00 AM - 4:30 PM (Flexible)
Duties And Responsibilities
* Track, monitor, and manage all correspondence related to patient refunds, offsets, and recoupments.
* Appeal, dispute, or process refund requests for amounts paid by health plans for services provided by Ameripharma.
* Analyze requests using internal documentation and notes. Leverage payer remittance notices, checks, EFTs, and banking information to support decision-making.
* Ensure timely posting of offsets to prevent duplicate work.
* Submit refund requests with supporting documentation when refunds are warranted by the paying entities.
* Maintain balanced tracking of all offset requests, ensuring accurate reporting.
* As the lead, provide all necessary information and instructions to various teams and departments regarding refunds and offsets.
* Serve as the primary point of contact for internal or external audits, providing all required information.
* Regularly update and provide assessment reports on all offset and refund requests.
* Utilize MS Excel for required reporting and status tracking.
* Offer clear and detailed instructions to team members regarding refunds, offsets, and recoupments.
* Supervise the daily work of team members, offering guidance, instructions, and training as needed.
* Ensure all refund, offset, and recoupment requests are properly documented in the EDI system.
Required Qualifications
* Proficient in reading, writing, speaking, and understanding English.
* Ability to interpret and reconcile remittance notices.
* Collaborative and cooperative with team members and management to support pharmacy needs.
* Strong time management, communication, interpersonal, multitasking, and prioritization skills.
* Excellent interpersonal skills with a strong analytical background.
* Ability to support colleagues in a fast-paced, ever-changing environment; service-oriented with high social perceptiveness.
* Capable of working independently with minimal guidance.
* Strong typing skills with minimal errors.
* Proficient in reading, analyzing, and interpreting data.
* Ability to apply logical thinking and common sense to a wide range of intellectual and practical problems involving both abstract and concrete variables.
* Availability to work hours necessary to complete all projects and duties in a timely manner.
Education And Experience Requirements
* High school diploma required.
* 3-5 years of experience in revenue cycle management, preferably in a specialty pharmacy or home infusion setting.
* Knowledge of managed care, commercial insurance, and government programs.
* Familiarity with automated billing systems; experience with CPR+ is preferred.
* Advanced proficiency in Word, Excel, and Outlook.
AmeriPharma’s Mission Statement
Our goal is to achieve superior clinical and economic outcomes while maintaining the utmost compassion and care for our patients. It is our joint and individual responsibility daily to demonstrate to our patients, prescribers, colleagues, and others that We Care!
Physical Requirements
The following physical activities described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions and expectations.
EEO Statement
The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required. The duties and responsibilities of this position are subject to change and other duties may be assigned or removed at any time. AmeriPharma values diversity in its workforce and is proud to be an AAP/EEO employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, sexual orientation, gender identity, national origin, age, protected veteran status, or on the basis of disability or any other legally protected class.
Seniority level
Mid-Senior level
Employment type
Other
Job function
Other
Industries
Hospitals and Health Care
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