Ardon Health

Based in Portland, Oregon, Ardon Health offers specialty pharmacy care with a human touch. We embrace the full health ecosystem —because getting better isn't just about filling a prescription. To foster good health, we connect patients, providers, manufactures, payers and the community with healthy tools and resources.

Ardon offers a unique and modern work environment that blends teamwork, excellence and open communication. Our team members grow and develop skills together while providing a high-quality, well-rounded patient experience.

We are seeking a Billing and Insurance Specialist. The Billing and Insurance Specialists provides exceptional service to patients by supporting all processes related to billing management; will be an expert in claims processing, complex benefits investigation, prior authorization processing, copay assistance programs and foundations, as well as liaison between third-party providers and patients/providers; assists team with troubleshooting and resolution of escalated inquiries Maintains current knowledge of and information on CMS and Medicaid pharmacy benefit changes.

Primary Functions:
01.    Electronically submits prescription insurance claims and completes benefits investigations
02.    Electronically submits test claims.
03.    Processes and follows up on payer denials, consulting with the insurance plan and patient as needed.
04.    Acts as a resource to the call center to troubleshoot issues and inquiries. 
05.    Communicates with patients and clients regarding service requests and account balances.
06.    Educates patients and physician office staff on all company programs and services.
07.    Receives and sorts incoming payments and posts payments in a timely manner.
08.    Receives and sorts incoming patient documents, scans documents to appropriate folder, and files hard copy accordingly. 
09.    Researches and resolves major medical and pharmacy billing issues.
10.    Manages outstanding balances and related communications.
11.    Audits patient accounts for outstanding balances and provides invoices for accounts with active balances, payment plans, or as requested.  
12.    Acts as a resource to the call center to troubleshoot issues and inquiries related to billing or major medical and pharmacy claims. 
13.    Assists Front End Operations and Back End Operations in resolution of internal department inquiries and provide order and claims assistance.
14.    Supports duties of resource, call center, and insurance teams. 
15.    Processes patient credit card payments and aids in credit card payment issue resolution.
16.    Provides inbound phone support for patients, providers, and third party plans.
17.    Handles complex coordination of benefits for patients with more than one type of insurance.
18.    Handles all aspects of prior authorization processing including initiating new prior authorization requests, updating existing authorizations, completing authorization renewals, and seeking authorization overrides.  
19.    Provides outbound communication for patients, providers, and third party payers for all delays, issues, or requests received while patient referrals are within the insurance stages. 
20.    Initiates timely, accurate, courteous, and concise responses to escalated inquiries.
21.    Assists in connecting patients with copay assistance programs and foundations.
22.    Troubleshoots adjudication issues and becomes well versed in the nuances of insurance billing and benefit investigation.
23.    Communicates with patients as needed regarding prescription claims processing and refers any medication or illness related questions or concerns to a board licensed healthcare professional, including but not limited to nurses, pharmacists, and supervised pharmacy interns.
24.    Maintains documentation of incoming and outgoing calls to and from patients.
25.    Contacts patients to schedule deliveries, confirm addresses, inform of any co-payments involved, and notify of payment responsibilities when business needs arise.
26.    Communicates patient status to physician offices and clinics.
27.    Maintains patient confidentiality. 
28.    Demonstrates regular attendance in conformance with the Ardon Employee Handbook standards, which may be revised from time to time and are essential to the successful performance of this position. 
29.    Maintains active Oregon license. Immediately informs supervisor (and Oregon Board of Pharmacy within 10 days) of any arrests, convictions, suspected or known violations of law, or any other conduct that might affect or has affected license status. Reports to Oregon Board of Pharmacy within 15 days any residence address or employment changes.
30.    Actively participates and provides support as needed to leadership and quality program staff to ensure activities related to the company’s quality management program and quality improvement activities maintain priority focus and are effectively executed. This may include but is not limited to activities that promote objective and systematic measurement, monitoring, and evaluation of services and defined Quality Improvement Projects (QIPs) that may result from such efforts.
31.    Complies with the company’s Human Resources policies, Employee Handbook, Code of Conduct, and all department policies and procedures, including protecting confidential company, employee, and customer information; attending work punctually and regularly; and adhering to good safety practices in all activities.
32.    Performs other duties and responsibilities as assigned.
 

What is a day at Ardon like? When we aren’t diligently working to change our patients’ lives, we’re planning potlucks, playing foosball, or celebrating this month’s birthdays (cake and balloons required). Each day we come to work excited and enjoy what we do. Our progressive environment embodies the notion that life is meant to be shared and lived well, through hard work, compassion, camaraderie and community.

We work to build trusted relationships and to be a resource that patients can turn to for help. We value this responsibility and take great pride in the opportunity we have to meet the specialty pharmacy needs of our customers. Team Ardon has a passion for providing great service and helping others. 

Required Skills:01.    Successfully meets all primary functions of Patient Care Advocate I and II positions. 
02.    Minimum 2 years’ experience in a medical office, call center, health insurance plan, or pharmacy, working with medical or pharmacy billing.
03.    High school diploma or equivalent GED.  
04.    Typing a minimum of 45 words per minute is required. Must pass typing test.
05.    Proven success with multi-tasking and the ability to troubleshoot and resolve issues relating to prescription operations
06.    Ability to be innovative and solution oriented and to strive for best practices.
07.    Ability to shift direction based on business needs while successfully remaining focused.
08.    Proven teamwork and a positive outlook are essential characteristics of this role.
09.    Excellent verbal, written, and interpersonal communication skills.
10.    Ability to accurately utilize applicable computer software and equipment for pharmacy claims processing.
11.    Ability to identify claims issues and re-process them as necessary.
12.    Strong knowledge of insurance plans, Patient Assistance Programs, and foundations, with the ability to assist patients to coordinate insurance benefits and/or explore options for copay and other financial assistance. 
13.    Ability to manage and support special projects as assigned.
14.    Ability to manage escalated issues that occur within pharmacy software system work queues. 
15.    Ability to assist with ad hoc reports regarding benefits and claim adjudication.
16.    Ability to assist in communicating and maintaining relationships with outside vendors.
17.    Ability to understand and interpret complex claims adjudication issues with Pharmacy Benefit Management organizations, insurance plans, and Patient Assistance Programs
18.    Demonstrated proficiency with computer applications.
19.    Ability to multi-task and work in a fast-paced environment
20.    Ability to work independently and as part of a team.
21.    Ability to arrive at work on time on a daily basis.
22.    Active Oregon Certified Pharmacy Technician license.
 

Ardon Health seeks to allow equal employment opportunities for all qualified persons without regard to race, religion, color, age, sex, sexual identification or orientation, national origin, marital status, disability, veteran status or any other status protected by law.