Reimbursement Specialist

Description

Summary

The Revenue Reimbursement Specialist works to ensure that we are optimizing insurance collections, reducing outstanding balances, and maintaining the accounts receivables. Revenue Reimbursement Specialists will maximize reimbursement for all services while minimizing the amount of time it takes to obtain reimbursement; decrease AR sustain a low DSO.

Responsibilities

• Communicate directly with the payor, resubmits denied claims, underpaid claims and claims that are inaccurately processed by auditing accounts to check on proper payments, coding, balances, adjustments, etc. using appropriate reports and queues
• Review and analyze claim denials in order to perform the appropriate appeals necessary for reimbursement 
• Manage outstanding accounts receivable for assigned payers/Divisions. Resolve outstanding balances. 
• Follow up on outstanding accounts receivables, 31-60 days, 61-90 days. Includes researching aged account reports, outstanding “list”, processing problematic EOB’s and/or incoming mail or correspondence as identified. Special projects on 90+ days detailing problematic accounts and reporting them to the supervisor.
• Identify errors, correct and communicate to management
• Additional Responsibilities:
• Conduct random audits to verify system integrity, payer accuracy and payment per contract, to optimize reimbursement functions.
• Other duties as assigned
• Focus may be on claims or charges not paid at the correct contract rate.

Requirements

Skills and Competencies

• Accounts Receivable knowledge: ability to read, analyze and interpret EOB’s and other AR procedures
• Adheres to organizational policies and procedures, including Corporate Compliance Program, HIPAA regulations.
• Knowledge of Medicare, Medicaid, HMO/PPO/EPO, Work Comp and Commercial Insurance operating procedures
• Ability to effectively correspond and interact with insurance payers, co-workers, management both verbally and in writing.
• Detail Oriented with organizational and problem-solving skills.
• The ability to work in a fast-paced environment

Requirements/Qualifications 

• High School Graduate
• Minimum 2 years’ experience in Healthcare Revenue Cycle
• Strong problem-solving skills and the ability to make timely decisions 
• Knowledge of Federal, State and third-party payor reimbursement rules and 
• regulations 
• Certified Coder preferred, but not required

This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve. Salary is commensurate with experience, skills and qualifications.

Base salary offers for this position may vary based on factors such as location, skills and relevant experience. We offer the following benefits to those who are benefit eligible (30+ hours a week):  medical, dental, vision, life and AD&D insurance, long and short term disability, 401k program with company match and profit sharing, wellness program, health savings accounts, flexible savings accounts, ID protection plan and accident, critical illness and hospital benefits. In addition, we offer paid holidays and paid time off.