Crossroads
Authorization Specialist - Buy and Bill Pharmacy
Crossroads, Greenville, South Carolina, us, 29610
Authorization Specialist - Buy and Bill Pharmacy
Crossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Since 2005, Crossroads has been at the forefront of treating patients with opioid use disorder. Crossroads 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. As an Authorization Specialist - Buy and Bill Pharmacy, your responsibilities will include: Performs 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. Leverage available resources and systems to analyze patient accounting information and take appropriate action for payment resolutions. Communicate professionally with payer resources to include websites/payer portals, e-mail, telephone, customer service departments, etc. Maintain quality and productivity results at a level that meets departmental standards. Verify patient benefits and eligibility for buy and bill drugs. Obtains 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 patient for co-pay assistance program as applicable. Demonstrate clear proficiency in third-party billing requirements to include federal, state, and commercial/managed care payers. Interpret claim scrubber edits/rejections and takes 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. Requirements for this role include: Must have had at least 2-3 years accounts receivable experience in a physician office setting. Has 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. Must have a High School Diploma/GED. Benefits of this role include: Have a daily impact on many lives. Excellent training if you are new to this field. Mileage reimbursement (if applicable). Community events that promote belonging and education. Opportunity to save lives every day. Medical, Dental, and Vision Insurance. PTO. Variety of 401K options including a match program with no vesture 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.
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Crossroads Treatment Centers is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. Since 2005, Crossroads has been at the forefront of treating patients with opioid use disorder. Crossroads 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. As an Authorization Specialist - Buy and Bill Pharmacy, your responsibilities will include: Performs 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. Leverage available resources and systems to analyze patient accounting information and take appropriate action for payment resolutions. Communicate professionally with payer resources to include websites/payer portals, e-mail, telephone, customer service departments, etc. Maintain quality and productivity results at a level that meets departmental standards. Verify patient benefits and eligibility for buy and bill drugs. Obtains 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 patient for co-pay assistance program as applicable. Demonstrate clear proficiency in third-party billing requirements to include federal, state, and commercial/managed care payers. Interpret claim scrubber edits/rejections and takes 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. Requirements for this role include: Must have had at least 2-3 years accounts receivable experience in a physician office setting. Has 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. Must have a High School Diploma/GED. Benefits of this role include: Have a daily impact on many lives. Excellent training if you are new to this field. Mileage reimbursement (if applicable). Community events that promote belonging and education. Opportunity to save lives every day. Medical, Dental, and Vision Insurance. PTO. Variety of 401K options including a match program with no vesture 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.
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