Reimbursement CoordinatorSan Bruno, CA$19.50 / HRHours : 7 : 00 AM - 4 : 00 PM Monday - Friday POSITION SUMMARY : Under the general supervision of the Reimbursement Supervisor / Manager, is responsible for various reimbursement functions, including but not limited to accurate and timely claim submission, claim status, collection activity, appeals, payment posting, and / or refunds, until accounts receivable issues are properly resolved.

PRIMARY DUTIES AND RESPONSIBILITIES : -Completing / Conducting Benefit Investigations-Completing Prior Authorizations and determining best approach for a PA process-Transferring Cases to Specialty Pharmacies-Follow-up Calls to Insurances-Conducting Alternative Coverage searches-Creating letters of medical necessity-Drafting appeal letters-Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program-Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications-Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payors.

Researches and resolves any electronic claim denials-Researches and resolves any claim denials or underpayment of claims-Effectively utilizes various means for collections, including but not limited to phone, fax, mail, and online methods-Provides exceptional customer service to internal and external customers;

resolves any customer requests in a timely and accurate manner; escalates complaints accordingly-Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers-Reports any reimbursement trends / delays to supervisor (, claim denials, pricing errors, payments, etc.

Processes any necessary insurance / patient correspondence-Provides all necessary documentation required to expedite payments.

This includes demographic, authorization / referrals, National Provider Identification (NPI) number, and referring physicians-Coordinates with inter-departmental associates to obtain appropriate medical records as they relate to the reimbursement process-Maintains confidentiality in regards to patient account status and the financial affairs of clinic / corporation-Communicates effectively to payors and / or claims clearinghouse to ensure accurate and timely electronically filed claims-Works on problems of moderate scope where analysis of data requires a review of a variety of factors.

• Exercises judgment within defined standard operating procedures to determine appropriate action-Typically receives little instruction on day-to-day work, general instructions on new assignments-Performs related duties as assignedMINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS : -Must have recently experience with Health Insurance-Ability to communicate effectively both orally and in writing-Ability to build productive internal / external working relationships-Strong interpersonal skills-Strong negotiating skills-Strong mathematical skills-Strong organizational skills;
• attention to detail-General knowledge of accounting principles, pharmacy operations, and medical claims-General knowledge of HCPCS, CPT, ICD-9 and ICD-10 coding preferred-Global understanding of commercial and government payers preferred-Ability to proficiently use Microsoft Excel, Outlook and Word-Is developing professional expertise;

Last updated : 2024-05-12