The core duties and responsibilities of a onePHG Reimbursement Specialist are to submit requests for payment to insurance companies and resolve outstanding issues for all types of insurance claims. The importance of clean, accurate, and complete initial claim submissions is of utmost importance. Researching and rectifying inaccurate submissions and denials along with benefit pre-certification and verifications are also required, in addition to other duties as assigned. This position reports to our Director of Payer Relations.

Responsibilities & Duties:

· Review Insurance claim forms for completeness and accuracy

· Process insurance and third-party payor claims through:

o ClaimsMD

o CounselEAR

o Other electronic and/or manual systems as necessary

o Various state Vocational Rehabilitation organizations

o Workers’ Compensation entities/companies

· Rectify inaccurate or missing information on HCFA forms

· Review and address Claims Rejections

· Own the appeals process

· Obtain insurance Prior Authorization approvals before services/devices performed or issued to patient

· Support and assist PCC & Providers in multiple one PHG offices with the claims and reimbursement process

· Maintain and manage insurance aging reports

· Create and maintain tracking tools such as Microsoft Excel and create reporting data as requested

· Meet daily/weekly/monthly verification goals

· Attend and contribute to Team meetings

· Be a resource for the accounting and other departments regarding claims details

· Other duties as assigned

Skills & Qualifications:

· Minimum of a High School diploma or GED

· Prefer a minimum of 2 years of medical claims processing experience including Medicare, Medicaid, major commercial health insurance and secondary payers.

• Solid understanding of medical insurance benefits including deductibles, copay and coinsurance.

· Exceptional attention to detail is critical

· Desire and ability to provide excellent customer service to internal and external customers

· Knowledge and/or ability to learn ICD and CPT codes

· Above average computer knowledge and experience, particularly in Microsoft Excel

· Strong organizational & time management skills

· Problem solving capabilities

· Capable of handling multiple tasks and patient files at a time

· Excellent verbal and written communication skills

· Accurate and efficient data entry skills

This position offers a competitive salary, opportunities for professional growth, and a supportive work environment. If you have a passion for healthcare finance and enjoy working in a collaborative team setting, we encourage you to apply for the Reimbursement Specialist position.

Job Type: Full-time

Pay: $20.00 - $23.00 per hour

Expected hours: 40 per week

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Work setting:

• Office

Work Location: In person