Verify insurance information utilizing available resources, assign appropriate financial class, and ensure appropriate assignment of procedure and diagnosis codes in accordance with internal policies and procedures. Manage billing processes for third-party claims; review explanation of benefits for accuracy of payment and compliance with contractual discounts. Resolve claim discrepancies through direct communication with insurance companies. Follow-up on unpaid claims within the standard billing cycle timeframe (30 - 45 days). Identify and submit claims to secondary and/or tertiary insurances after primary payment is receipt. Provide prompt, courteous customer service to patients; research/resolve account discrepancies.

Verified insurance information utilizing available resources, assigned appropriate financial class, and ensured appropriate assignment of procedure and diagnosis codes in accordance with internal policies and procedures. Managed billing processes for third-party claims; reviewed explanation of benefits for accuracy of payment and compliance with contractual discounts. Resolved claim discrepancies through direct communication with insurance companies. Followed-up on unpaid claims within the standard billing cycle timeframe (30 - 45 days). Identified and submit claims to secondary and/or tertiary insurances after primary payment receipt. Provided prompt, courteous customer service to patients; researched/resolved account discrepancies. .

Worked with payers and various outside agencies to verify information, ensure accurate processing, and resolve potential clinical and non-clinical issues related to patient medication billing. Ensured pharmacy claims approval by performing a series of edits to discover denials during the on-line adjudication process (wrong NDC number, refills too soon, brand vs. generic, etc.), by resolving discrepancies with Purchasing Associates, Pharmacists, Directors of Nursing (DON´s) and/or Nursing Staff. Identified and pro-actively resolved denied claims prior to medication delivery, worked with insurance companies, Medicaid, nursing home facilities, and pharmacy staff to ensure minimal loss of non-reimbursed inventory. Followed-up with Directors of Nursing and nursing staff to communicate unresolved denials or status changes allowing alternate courses of therapy to be prescribed. Completed the necessary authorization forms (Certification of Medical Necessity, Prior Authorization Forms, Therapy Change, Authorization of non-covered medications, etc.) to ensure appeals were executed with physicians, DON´s and claims processors in a timely manner. Adhered to policies and procedures in order to conform to Sarbanes Oxley and PharMerica requirements. Maintained organized files of appropriate documentation required by state and federal agencies.

Maintained direct communication with third-party insurers, Medicaid, Medicare and assigned pharmacy locations to resolve unapplied cash issues and account discrepancies in a timely manner. Provided high-quality customer service to responsible parties; resolved delinquent accounts; and explained billing statements. Worked in conjunction with billing associates in obtaining accurate billing, resident information, and rebilling/resolving unpaid claims through adjudication. Engaged collection manager/supervisor in complex pharmacy accounts requiring leadership review after all actions have been taken to collect monies owed. Supported assigned pharmacy locations, nursing home accounts and individual customers in receiving inbound correspondence and mailing outbound collection letters for 90 day active/inactive accounts and discontinuation of service letters.

Handled all accounts receivable related administrative functions, including contacting delinquent customers via phone to secure payment, assisted with printing and mailing of statements, reviewed account histories with customers, and posted payments, credit memos and adjustments. Filed and faxed customer invoices and pertinent information. Met and/or exceeded monthly accounts receivable goals.

Collected delinquent bills by making outbound telephone calls to customers.

Collected delinquent bills by making outbound telephone calls to customers or by written correspondence when appropriate. Recorded data, notations, and entered data online while speaking with customers via telephone. Handled adjustments as appropriate to resolve discrepancies, facilitated payment arrangement negotiations and extensions of credit. Computed and quoted adjustments, credit/security requirements, balances, amounts billed and/or rates to customers.