Remote Insurance Collections Services Associate

«out Conduent ***Conduent is hiring a Remote Insurance Collection Service Associate*** Candidates with Medical Collections and Medicare experience desired Pay - $17-20 per hour based upon experience Schedule - 6:30am - 3:00pm PST Remote Position Job Description 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. Job Description • Analyzes claim overpayments which are a result of incorrectly paid claims arising from COB issues, data mining, duplicate claim payments, client referrals, etc. • Coordinates collection efforts between the client and the provider, adjusting claims as required. • Handles disputes and appeals from providers and clients. • Prepares claims for offset by the client. Closing Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law. People with disabilities who need a reasonable accommodation to apply for or compete for employment with Conduent may request such accommodation(s) by clicking on the following link, completing the accommodation request form, and submitting the request by using the