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Genetics for Smarter Medication Management

Admera Health is seeking a Reimbursement Specialist to join our growing team!

Title: Reimbursement Specialist
Department: Billing
Location: South Plainfield, NJ
Admera Health is a leading precision medicine company providing a suite of high-integrity pharmacogenomics (PGx) solutions, diagnostic testing, and biopharmaceutical research services. PGx, the study of how genes affect a person’s response to drugs, combines the fields of pharmacology and genomics to develop effective, safe medications and dosing recommendations tailored to a person’s genetic makeup. PGx testing may help reduce adverse drug reactions (ADRs), which some estimates place as the fourth leading cause of death – resulting in more deaths than lung disease, diabetes, AIDS, pneumonia, and accidents. For every healthcare dollar spent on medications, an additional 50% is spent on addressing ADRs. Admera Health’s flagship product, PGxOne™ Plus, is a comprehensive test built on the foundation of enabling smarter and safer medication management. The test incorporates next-generation gene sequencing design applications and expert data curation to deliver biological systems based medically actionable results. In addition to PGx services, Admera Health leverages existing knowledge and infrastructure to offer related clinical services and robust biopharmaceutical genomics solutions to researchers worldwide.

Responsibilities:

  • Make sure every claim has an accession number
  • Verify that diagnosis codes are entered during accession in the correct relevant order
  • Perform eligibility verification
  • Contact patients to offer alternate payment options when applicable
  • Claim Status through Navinet
  • Prior authorizations, if necessary
  • Gather necessary info from Doctor’s offices and patients
  • Submit electronic claims using Healthpac through Zirmed
  • Submit paper claims as needed
  • Initiate appeal requests and follow-up with requests to verify the Insurance Carriers received the request
  • Research Overpayment inquiries, if actual overpayment, request that payor appeals credit balance to future payments, or make payment directly to payor
  • Complete Redetermination form from payor. Fax to payor and scan into patient’s chart
  • Initiate Reconsideration process and ensure that information is received by payor
  • Gather needed information for billing company
  • Scan EOBs into assigned folders
  • Assemble documents and present information request to payors
  • Obtain claim status through IVR, payor websites or direct calls to payor’s claim processing unit
  • Track and Process patient billing
  • Other projects and tasks as needed

Qualifications:

  • 2+ years’ experience working as a medical biller with laboratory experience OR
  • 3+ years’ experience working as a medical biller without laboratory experience
  • Highly proficient in Microsoft Office, specifically Excel
  • Excellent computer skills and ability to navigate multiple software systems as well as web portals to perform daily tasks
  • Excellent verbal and written communication skills
  • Extremely organized and able to prioritize tasks effectively
  • Ability to work independently
  • Demonstrate excellent team skills, positive attitude and high ethical standards
  • Experience with XIFIN preferred but not required
Admera Health employees have a winning attitude and champion innovation, teamwork and accountability through a results-oriented, customer-centric, and fun culture. We offer various health and financial benefits, learning opportunities, competitive compensation, rewarding bonus programs, and a wide range of work/life benefits designed to make your life easier.
For more information, please visit www.admerahealth.com.
To review and apply to our open positions, please visit www.admerahealth.com/careers.
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