Patient Billing Specialist 3-Cash Collections
Location: San Diego
Posted on: February 16, 2020
Founded in 1999, Dexcom, Inc. provides continuous glucose
monitoring technology to help patients and their clinicians better
manage diabetes. Since our inception, we have focused on better
outcomes for patients, caregivers, and clinicians by delivering
solutions for people with diabetes - while empowering our community
to take control of diabetes.
Responsible for carrying out various insurance related tasks
associated with Dexcom's product offerings. Daily activities may
include, but are not limited to: benefits eligibility, determining
coverage levels, submitting prior authorization requests to
insurance company and following up on outstanding authorization
requests until an outcome is determined; as well as, various
post-claim submission activities. Will act as a liaison between the
insurance carrier, Regional Account Directors, Customer Operations
Personnel, inside & outside sales, and billing teams.
Essential Duties and Responsibilities:
- Processes opportunities staged and statused under Managed Care
responsibilities requesting authorization and perform appropriate
following up on auth-requests
- Performing opportunity and benefit analysis to capture benefit
data within ERP system including (but not limited to) risk entity,
estimated out of pocket expenses, deductible, co-pay, and
co-insurance amounts, authorization start & end dates, and similar
- Prepares correspondence to insurance companies, Health Care
Professionals (HCPs) & other affiliates on behalf of patients, such
as authorization requests, appeals & letters of agreement
- Clearly documents all correspondence in the company
- Troubleshoots and seeks solutions to problems related to
questions and concerns over health insurance coverage and
explanation of benefits, orders and sales efforts.
- Coordinate efforts to increase access to & awareness of CGM
with Insurance Companies
- Review payor document requirements and provide the Regional
Account Directors with data to support broader access to CGM
- As assigned:
- Manage and track claims process for payor(s)
- Proactively follow up on claim status, re-billing,
- Review Explanation of Benefits statements and take appropriate
action via verbal or written appeal to challenge short/zero paid
claims and various denials.
- Ensures claims are paid according to contractual
- Demonstrate proven knowledge and technical skills to perform
insurance follow-up with positive financial results to include
accuracy, timeliness, and attention to detail.
- May perform administrative functions such as answering incoming
calls and placing calls to/from patients, healthcare professionals
and insurance companies.
- May be asked to provide backup coverage for other geographic
territories or MCS responsibilities (i.e. authorization or benefit
- May be required to explain Continuous Glucose Monitoring System
(CGMS) insurance benefits coverage to payors and describe the
functions and supplies that go with CGMS.
- This position assumes and performs other duties as
- Requires a minimum of 4 years of related experience
- Must understand the intricacies of medical and pharmacy
insurance coverage as it pertains to Durable Medical
- Must know and understand the difference between HMO, PPO, EPO,
Indemnity, POS, Home Plans and Host Plans and be able to clearly
communicate that to a patient and or other caregiver or medical
- Ability to learn and retain the specific criteria and
requirements for different insurance plans
- Must be able to create Word documents, work in Excel, use
templates, use the internet, Outlook and work in a company created
- Must possess strong organizational and time management
- Strong communication skills for speaking with patients,
parents, physicians, physician offices, and Dexcom affiliates
- Knowledge of diabetes
- Strong understanding of insurance revenue cycle
- High School diploma/certificate or equivalent
- 0 - 24%
Language Skills: Must be able to communicate effectively in
English. Ability to read and interpret documents such as safety
rules, operating and maintenance instructions, and procedure
manuals. Ability to write routine reports and correspondence.
Ability to speak effectively before groups of customers or
employees of organization.
Physical Demands: The physical demands described here are
representative of those that must be met by an employee to
successfully perform the essential functions of this job.
Reasonable accommodations may be made to enable individuals with
disabilities to perform the essential functions. May be required to
perform the following Physical Activity: Standing, walking,
sitting, using hands, handle or feel, reach with hands and arms,
climb or balance, stoop, kneel, crouch, or crawl, talk or hear,
taste or smell. May be required to lift 0 lbs. to over 100 lbs.
Work Environment: The work environment characteristics described
here are representative of those an employee encounters while
performing the essential functions of this job. Reasonable
accommodations may be made to enable individuals with disabilities
to perform the essential functions. May be exposed to the following
environmental conditions: Wet or humid conditions, work near moving
parts, work in high - precarious places, fumes or airborne
particles, toxic or caustic chemicals, outdoor weather conditions,
extreme heat (non-weather), extreme cold (non-weather), risk of
electric shock, work with explosives, risk of radiation, vibration.
The noise level in this work environment can range from quiet to
Please note: The information contained herein is not intended to be
an all-inclusive list of the duties and responsibilities of the
job, nor are they intended to be an all-inclusive list of the
skills and abilities required to do the job. Management may, at its
discretion, assign or reassign duties and responsibilities to this
job at any time. The duties and responsibilities in this job
description may be subject to change at any time due to reasonable
accommodation or other reasons.
An Equal Opportunity Employer. All qualified applicants will
receive consideration for employment without regard to race, color,
religion, sex, sexual orientation, gender identity, national
origin, or protected veteran status and will not be discriminated
against on the basis of disability.
If you are an individual with a disability and would like to
request a reasonable accommodation as part of the employment
selection process, please contact Talent Acquisition at
To all Staffing and Recruiting Agencies: Our Careers Site is only
for individuals seeking a job at Dexcom. Only authorized staffing
and recruiting agencies may use this site or to submit profiles,
applications or resumes on specific requisitions. Dexcom does not
accept unsolicited resumes or applications from agencies. Please do
not forward resumes to the Talent Acquisition team, Dexcom
employees or any other company location. Dexcom is not responsible
for any fees related to unsolicited resumes/applications.
Keywords: Dexcom, San Diego , Patient Billing Specialist 3-Cash Collections, Accounting, Auditing , San Diego, California
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