Overview
Continued growth at Maxor has created an opportunity for a Billing Specialist. The Billing Specialist is responsible for preparation and submission of clean claims to third party insurance carriers, Medicare, Medicaid, copay assistance programs and foundations either electronically or by hard copy billing. This includes primary, secondary, and tertiary claims.
Position Location
This is a remote-based position within the Continental US.
Our Company
Founded in 1926, Maxor is a leading, independent pharmacy solutions platform that improves prescription drug affordability and outcomes. Over time, Maxor has built a unique and complementary suite of services and technology offerings that deliver clinical, financial and strategic value to patients, payors and providers across the pharmacy supply chain. Maxor has a proud heritage of growth and innovation earned over the decades. Amarillo, Texas is the legacy headquarters for Maxor, but our talent base is national. We operate pharmacies and other business operation sites across the United States with more than 1200 employees working from 42 states.
Why Maxor?
Pharmacies are essential to healthcare, with nearly 90% of the US population living within 5 miles of one and seeing their pharmacist an average of 12 times a year. Providing a positive patient experience is crucial to ensuring patients adhere to their therapies. At Maxor, we recognize that our employees are our most valuable assets. We actively seek and retain talented professionals who are mission-driven to improve healthcare outcomes for patients. Our employees are essential to their own well-being, finding fulfillment in meaningful work, competitive compensation, diverse and inclusive teams, and limitless career possibilities. With a workforce of 1,000+ and almost a century of pharmacy experience, we offer the stability of a Fortune 500 company and the energy and innovation of a startup. Our expertise and technology support the entire pharmacy ecosystem, but our impact goes beyond pharmacy services. We enable pharmacy care.
Responsibilities
ESSENTIAL FUNCTIONS (These duties must be performed with or without reasonable accommodation. This document in no way states or implies that these are the only duties to be performed by the employee occupying this position):
Prepare and submit clean claims to third party insurance carriers, Medicare, Medicaid, copay assistance programs and foundations either electronically or by hard copy billing. This includes primary, secondary, and tertiary claims.
Assist in billing some secondary NCPDP/RX claims including claims secondary to Medicare.
Assists in making adjustments on accounts receivable collections and maintaining the patient financial record including adjustments due to secondary NCPDP/RX claims.
Submit PA request to Texas Medicaid & their managed care plans for supplies.
Appeal Medicare and Texas Medicaid claims when necessary and follow-up until complete.
Process denied/rejected claims by correcting any billing error and resubmitting claims to third party insurance carriers.
Communicate with Pharmacists and other staff to ensure that all necessary information is in place prior to filing claims.
Perform Medicare and Texas Medicaid eligibility checks.
Responsible for calculating Medicare pricing for new referrals, as well as patient responsibility for refills.
Responsible for ensuring Medicare patients meet criteria and we have everything Medicare requires prior to approving an initial dispense and refills. This includes requesting medical documentation when necessary.
Responsible for working various daily, weekly, and monthly reports related to billing functions.
Maintains a good working knowledge for all payer and provider contracts.
Reports financial information to the Director of Reimbursement Services and other appropriate management as needed.
Keep updated on all third party billing requirements and changes for insurance types within their area of responsibility.
Demonstrate knowledge of and supports policies and procedures, operating instructions confidentiality standards, and the code of ethical behavior. Scan CMS-1500’s and supporting documentation on M-drive.
Meets performance standards and expectations.
Follows all Company policies and procedures.
Assists with projects as necessary.
Assists other areas as needed.
Assists in compiling necessary reports and/or audit information as requested.
Works cooperatively with other staff members to promote a positive and team oriented work environment.
Participates in the Performance Improvement/Quality Management/and Adverse Event/Product Complaint Processes.
Maintains accurate and complete patient records.
Participates in pharmacy orientation programs, training programs, pharmacy, Specialty monthly meeting, in-services, and other programs as required.
Exemplifies excellence in customer communications and service.
Has a good understanding and working knowledge of all Maxor policies and procedures, accreditation requirements and HIPAA operational guidelines.
Must be able to cope with the mental and emotional stress of the position and duties.
Promptly report any allegations of impropriety to the Compliance Department.
Comply with Maxor’s Ethical Business Conduct policy and Maxor’s Compliance Program.
Remain free from exclusion under the OIG and SAMS Medicare/Medicaid lists.
Complete required training, as assigned, within the established timeframes.
Maintain regular attendance in accordance with established policies.
Perform other job-related duties as assigned.
Qualifications
Education:
- High School Diploma or Equivalency
Experience:
- One-Two years relevant experience; any combination of the necessary knowledge, skills, and abilities.
Knowledge, Skills, and Abilities:
- Working knowledge of computer software, specifically Microsoft Office and Outlook
- Ability to accurately enter data into a computer system
- Ability to prioritize work to meet deadlines
- Ability to multi-task and work accurately under pressure
- Ability to work through and solve problems independently
- Positive attitude, innovative, self-starter
- Excellent organizational and communication skills, both written and verbal
WE OFFER:
A diverse, progressive culture that supports a work from home model, a “dress for your day” attire when working onsite, and a collaborative, team oriented environment. Our industry leading compensation and health benefits include:
- Comprehensive mental health and wellbeing resources
- Nationwide Blue Cross Blue Shield PPO with employee friendly plan design, including $850 individual annual medical deductible, $25 office visit copays, Low biweekly premiums
- Company paid basic life/AD&D, Short-term and Long-term disability insurance
- Rx, dental, vision, short-term disability, and FSA
- Employer-matched 401k Plan
- Industry leading PTO plan
- And MORE!
APPLY TODAY: https://www.maxor.com/careers/
Maxor is an EOE, including disability/vets
