The Reimbursement Specialist compiles, reviews, and processes billing and accounts receivable documents, insurance bills and payments, and prepares and maintains all accounts receivable and patient service revenue records and reports.

The Reimbursement Specialist :

• Compiles, reviews, and processes billing and accounts receivable documents, insurance bills and payments, and prepares and maintains all accounts receivable and patient service revenue records and reports.
• Prepares, reviews, and submits monthly billings according to established procedures. Matches bills with census and identifies discrepancies;

reviews patient billing revenues for accuracy.

• Records all payments as received, performs monthly reconciliation of cash receipts; and maintains accounts receivable records and reports.
• Reviews and corrects accounts receivable bills / records before transmission or mailing.
• Continuously works on clearing rejections, denials and returned claims, performing all necessary follow-up to ensure collection of payments from Medicare / Medicaid and Insurance providers.
• Completes billing audits to ensure accuracy and / or compliance.
• Receives and answers inquiries from insurance sources / Case Managers regarding patient status or obtaining updated authorizations.
• Contacts Medical Records as needed to acquire any information and records needed for billing.
• Coordinates the compilation and submission of information needed for Medicaid and Medicaid managed care providers, including obtaining authorizations.
• Continuously strives to improve processes and maintain high standards of quality and customer service.

Skills

Associates Degree with one year previous billing / medical office related experience preferred.

Bookkeeping or billing certification courses preferred. Or an equivalent combination of professional experience and education.

Demonstrated experience in general healthcare billing practice; proficiency billing with software.

Knowledge of Medicare / Medicaid billing regulation.

Familiarity with medical terminology.

Last updated : 2024-05-05