Option Care Specialist, Reimbursement EDI in Vernon Hills, Illinois

Option Care is a healthcare services company that at its core delivers high quality, cost effective infusion services through trusted partnerships across the healthcare system, resulting in outcomes that make a positive difference in people’s lives.

Job Description Summary:

The Corporate Reimbursement Specialist - EDI is responsible for electronic transactions between our organization and our payers. The payer base includes Medicare, Medicaid, managed care payers, commercial insurance carriers, and patients. They will also assist in completing provider enrollment applications.

Job Description:

Job Responsibilities (listed in order of importance and/or time spent)

  • Assists branch offices in electronic transmission of claims and remittances. Communicates with branch offices on projects extracted to Corporate.

  • Collaborates with branch Reimbursement Department to ensure processes are in place to enable timely and accurate electronic billing and collections.

  • Responsible in completing provider enrollment applications.

  • Responsible in creating user logins for several provider portals.

  • Participates in project progress calls, presenting progress success/failure information with plans of action.

  • Responsible for assisting in the creating and evaluating of documentation and training materials.

  • Responsible for maintaining confidentiality of patient and proprietary information. Complies with legal and ethical guidelines for safeguarding the confidentiality of patient and proprietary Option Care information.

Supervisory Responsibilities

Does this position have supervisory responsibilities? (i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.) No

Basic Qualifications & Interests (BQIs)

  • Experience in provider enrollment.

  • Experience working with Medicare and Medicaid.

  • Experience in Brightree, CPR+, Dezine, i-Emphsys, DayTech or other medical billing software.

  • Experience in identifying issues and recommending/implementing ways to resolve issues and problems.

  • Intermediate skill level with Internet Explorer and comfortable navigating provider portals.

  • Experience communicating both verbally (on phone, one-on-one, to groups) and in writing (emails, letters, reports, presentations) to various audiences (work group, team, company management, prospective acquisitions, external clients).

  • Intermediate level skill in Microsoft Excel (for example: using SUM function, setting borders, setting column width, inserting charts, using text wrap, sorting, setting headers and footers and/or print scaling).

  • Intermediate level skill in Microsoft PowerPoint (for example: applying a theme, formatting character spacing, inserting a picture, changing slide layout and theme colors, adding transitions, customizing slide numbers, changing chart style and/or formatting font).

  • Intermediate level skill in Microsoft Word (for example: inserting headers, page breaks, page numbers and tables and/or adjusting table columns).

  • Experience developing ways of accomplishing goals with little or no supervision, depending on oneself to complete objectives and determining when escalation of issues is necessary.

Travel Requirements: (if required)

Willing to travel up to 25% of the time for business purposes (within state and out of state).

This job description is to be used as a guide for accomplishing Company and department objectives, and only covers the primary functions and responsibilities of the position. It is in no way to be construed as an all-encompassing list of duties.

Option Care subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information.

Option Care is a leading provider of home and alternate treatment site infusion services. With a staff of more than 1,700 clinical experts – including specially trained infusion nurses, infusion pharmacists and registered dietitians – Option Care treats patients with a wide range of acute and chronic conditions. Comprehensive therapy management programs are offered for patients with nutrition disorders, bleeding disorders and heart failure, as well as those needing immunoglobulin (IG) therapy and anti-infective therapy. Option Care is able to provide services to 92% of the nation’s population through more than 90 infusion pharmacies and 100 alternate treatment sites across the country.