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Patient Account Analyst - Pharmacy Counter - Full Time - Days

Toledo, Ohio
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Description

Home Medical Equipment:  Rewarding work, team effort, patient centric.  


We are employer of choice if you like to help others by working in a team oriented atmosphere.  Strong learning curve, but once knowledge gained it is invaluable to you, both professionally and personally.  We provide medical equipment for people to use in their home such as wheelchairs, walkers, oxygen, sleep equipment, incontinence supplies and more.  Our patients reach us personally or through their physician or hospital.  Our team takes the order, verifies insurance, obtains medical documentation and script, dispenses the equipment either in our storefront or at the patient’s home and bills all patient related payer sources.  It takes determination, diligence, hard work and patience to navigate this complex healthcare arena so if you are up for a challenge and are a hard worker,  this is the place for you.

Assures that the claims data submitted to the Insurance Carriers is complete, accurate and in accordance with third-party payer reimbursement guidelines prior to submission.

  • Subject Matter Expertise: Basic knowledge of products and services provided by the company. Keep current with reimbursement guidelines, eligibility of coverage, pertinent billing information required for medical necessity of equipment.  Provide education to the physician practices, referral sources and branch staff regarding prescription requirements necessary to meet professional standards, accrediting standards and all Federal, State and local laws and regulations for delivery of equipment and services and submission of claims.  Able to efficiently and accurately identify and document accounts that require adding bills, reversing bills, changing bills, and deleting bills.
  • Operations: Assist in the acquisition of additional documentation to support medical necessity and approval for claims payment.  Identify and document accounts to be transferred to loan status or uncollectible and transfer to private pay carrier or bad debt and inform supervisor in an efficient time frame.  Verify insurance eligibility and obtain prior authorization when required.  Correct system data entry errors such as change of doctor, insurance carrier and documentation.  Work held revenue report by high dollar accounts and time limits to achieve maximum efficiencies in submitting bills and improving cash flow.  Document both hard copy and in the system the appropriate information to verify the logging of CMN or PAR and proceeding to claim submission.  Log and release held bill status for all appropriate claims.  Review all claims for accuracy (IE, coding, NDC codes, PA’s, Etc.,)
  • Customer service:  Work closely with insurance carriers to establish ongoing professional relationships to facilitate case collections.
  • Other duties as assigned.

  • Education: High school diploma or GED and experience in HME industry billing field
  • Skills: Able to demonstrate proficient skills in claims management in software system including invoice review, status codes, case notes and customer inquiry.
  • Years of Experience: Minimum of 1 to 2 years’ experience as Customer Service Representative in HME industry

 

ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio.  For more information, please visit www.promedica.org/about-promedica

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact employment@promedica.org

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