Insurance Reimbursement Specialist

JOB SUMMARY: 

The Insurance Reimbursement Specialist will be responsible for document retrieval, analysis, claim processing, and reimbursement.

ESSENTIAL FUNCTIONS:

• Have a full understanding of a medical claim cycle


• Possess the necessary knowledge to identify claim issues and apply resolutions to them


• Have a full understanding of the remit advice. Understand CAS codes and remark codes


• Understand and able to submit corrected claims, appeals, reconsiderations, medical necessity letters, etc.


• ICD diagnosis coding, modifier application and verification of CPT and/or HCPCS codes


• Responsible for ensuring all claims processed through EMR are correct and compliant


• Responsible for performing AR follow up


• Keeps abreast of and complies with coding guidelines and reimbursement reporting requirements.


• Daily review and follow up on all incomplete electronic provider-billing encounters.


• Ability to identify issues, correct code and/or pend due to missing information.


• Apply in depth knowledge of coding principles to validate missing or incomplete CPT, HCPCS, or ICD-10 codes.


• Appropriate assignment of diagnosis codes to CPT codes.


• Review and completion of claim edits


• Review of Denials including writing appeals and facilitating their submission.


• Have vast knowledge of medical insurance rules and proper filing guidelines


• Ability to maximize reimbursement for claims.


• Ability to run standard reconciliation reports.


• Answer patient calls/questions, clinic staff calls, and insurance company calls


• Ensure resubmission of claims, when applicable, are accurate


• Ensure reimbursement of claims by submitting the most appropriate coding for services performed


• Maintain a professional relationship with insurance companies and patients


• Other duties as assigned

QUALIFICATIONS REQUIRED:

• A minimum of 3 - 5 years of medical ICD & CPT coding experience, Family Practice or Clinic setting is preferred


• Electronic Medical Record experience, eCW software highly preferred


• Excellent communication skills


• Problem solving skills


• Computer literate with entry level working knowledge of Microsoft Suites; Outlook, Word, Excel


• Demonstrated ability to organize, coordinate, prioritize, and facilitate many on-going tasks at one time


• Duties require professional verbal and written communication skills


• Ability to work independently or with a team


• Professional appearance


• Positive attitude

MINIMUM REQUIRED EDUCATION/TRAINING:

• High School graduate or equivalent required


• Preferred but not required: AHIMA or CPC

Aylo Health is an Equal Opportunity Employer