Billing & Reimbursement Specialist

The Billing & Reimbursement Specialist handles day to day billing and collecting for multiple dialysis facilities.

 ESSENTIAL JOB FUNCTIONS

•  Acquires and maintains a current working knowledge of billing practices and changes in dialysis reimbursement and billing procedures.

• Determine prior authorization requirements for each patient/payor and establish procedures to obtain prior authorization.
• Work EOBs and Remittance Advice for Medicaid, Medicare, commercial and managed care insurance.
• Work rejected and denied claims, correct claims, and rebill within guidelines.
• Act as administrator for payer website/log in access as needed.
• Recommends new and/or revised policies and procedures as needed.
• Answers questions from patients, clerical staff, and insurance companies. Identifies and resolves patient insurance and billing issues.
• Performs various collection actions including correcting and resubmitting clean claims to secondary payers. Processes payments from insurance companies.
• Works closely with Social Worker to assure that all resources have been explored for financial needs.
• Maintains electronic folders of insurance carrier EOB’s and patient payments.
• Identify and troubleshoot electronic transmission issues and takes corrective action directly with the Electronic Clearinghouse.
• Additional duties as needed.

QUALIFICATIONS AND REQUIRED SKILLS:

• An associate degree from an accredited university with credentials in billing and coding preferred or equivalent experience.
• Previous medical billing experience including knowledge of billing related reporting; 3 - 5 years’ experience in health-care billing and collection practices. Use of Availity, QMS/QCS EMR and Billing system is a plus.
• Experience working with medical payers including Medicare, Medicaid, and commercial insurance.
• Working knowledge of medical billing systems.
• Experience with Medicaid’s State Eligibility System.
• Working knowledge of CPT and ICD-9 & ICD-10 coding systems.
• Excellent organizational skills
• Proficiency in Microsoft Office Suit.
• Works well in an environment with firm deadlines; results oriented.
• Perform multiple tasks effectively.
• Able to work both independently and as part of a team.
• Strong analytical skills required.
• Capable of making timely, independent decisions.