Job Description
Remote Insurance Collections Services Associate
Location: Remote, US
Categories: Client Relationship Management / Service Delivery
Req ID: 2023-80166
About Conduent
Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments – creating exceptional outcomes for our clients and the millions of people who count on them.
You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.
Job Description
***Conduent is hiring a Remote Insurance Collection Service Associate***
Candidates with Medical Collections and Medicare experience desired
Pay – up to $17-20 per hour based upon experience
Schedule – 6:30am – 3:00pm PST
Remote Position
Insurance Collections Services Associate – Pharmacy is responsible for seeking reimbursement/recovering overpayments from third parties, dispensing pharmacy providers, PBM’s, healthcare facilities and/or insurance carriers on overpaid NCPDP pharmacy drug claims for CPIS clients. These claim overpayments are a result of incorrectly paid claims arising from COB issues, data mining, duplicate claim payments, client referrals, etc. The Insurance Collections Services Associate II – Pharmacy is responsible to meet all performance standards: collection goals, compliance, and production to ensure calls are timely, maximum call time is achieved, and ensures quality results.
Insurance Collections Services Associate II – Pharmacy will handle the recovery of pharmacy related Medicare Part D, Medicaid and commercial claim overpayments identified through various audits. Responsibilities include (but are not limited to):
- Recovery of pharmacy claim overpayments through direct outreach via phone, e-mail, or fax method with pharmacies, PBM’s, insurance carriers.
- Communicates effectively with other staff/team members.
- Coordinates collection efforts between the client and the provider, adjusting claims/reversals as required.
- Develops effective collection approaches and workflows to maximize recovery opportunities.
- Communicates with plan carrier’s PBM regarding Medicare Secondary Payer requirements, as well as drug exclusions under Medicare Part D.
Experience:
- Strong background in pharmacy billing concepts, including pharmacy billing and claim recovery (collection) experience. Basic knowledge of insurance procedures, working with insurance carriers, Medicare, and Medicaid.
- General understanding of:
- Third-party reimbursement types (i.e. PBM, medication assistance programs, self-pay)
- Healthcare reimbursement in different settings (i.e., home health, long term care, home infusion, health systems, community pharmacy, and ambulatory clinics.
- Drug related reimbursement calculations in different forms (i.e., oral/PO, injections, infusions, topicals, etc.)
- Eligibility verifications surrounding BIN/PCN combinations and payer sheets
- Coordination of Benefits (COB) to determine each party’s responsibility.
- Interpreting EOB’s, ERA’s (electronic remittance advice) for understanding of allowable rates, rejection codes and patient accumulations.
- CMS guidelines surrounding Medicare Part D, including rejections, external code lists and drug exclusions
- Familiarity with NCPDP claims, NDC’s, and reimbursement terms.
- Experience with pharmacy PA’s and overrides preferred.
- Professional verbal and written communication skills required. Excel knowledge strongly preferred.
- Minimum 1-year experience with pharmacy billing/insurance collections.