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Patient Billing Specialist 3-Cash Collections

Company: Dexcom
Location: San Diego
Posted on: February 16, 2020

Job Description:

About Dexcom:
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.

Summary:

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 benefit data.
  • 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 databases.
  • 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 therapy
  • As assigned:
    • Manage and track claims process for payor(s)
    • Proactively follow up on claim status, re-billing, recalculations.
    • 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 agreements.
      • 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 investigation teams).
      • 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 assigned.

        Qualifications:

        • 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 Equipment
        • 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 professional
        • 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 database
          • Must possess strong organizational and time management skills
            • Strong communication skills for speaking with patients, parents, physicians, physician offices, and Dexcom affiliates

              Preferred Qualifications

              • Knowledge of diabetes
              • Strong understanding of insurance revenue cycle

                Education:

                • High School diploma/certificate or equivalent

                  Travel Required:

                  • 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 very loud.

                    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 talentacquisition@dexcom.com .

                    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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