Insurance Reimbursement Specialist

Job Title: Insurance Reimbursement SpecialistDepartment: BillingReports To: Revenue Cycle ManagerLocation: Shelton, CTTerms: Full-time FLSA Status: ExemptPOSITION SUMMARYAs an Insurance Reimbursement Specialist, you will work with insurance and billing companies to process medical reimbursements for patients. Your primary duties include claim review, appeal generation, interacting with patients, communicating with insurance providers, assist with retrieving EOBs, and other duties as assigned. To be successful in this role, you need strong analytical, communication, and organizational skills.ESSENTIAL FUNCTIONSResponsible for submission of appeals to national payersProvide review of all levels of an insurance appealGather supporting documentations (physician medical records, patient /physician letters etc.)Work incoming correspondence from payors to assist with claim appealInteract with utilization review/management departmentsAssist with gathering EOB’s if cash poster is unable to locateProvide excellent customer service via the handling of inbound and outbound calls/emails to patients and providersData EntryAssist with Error Processing when business volume dictates the needPERFORMANCE MEASURESReview claim denials within 1 week of posting to determine next step for accessionSubmit request to provider for necessary documentation for appeal- follow up on requests within 2 weeks if not received.Submit accessions for adjustments per Patient Transparency Program guidelines and document accession to reflect need for adjustment accuratelyFollow up with plans when trends of nonpayment or incorrect payment is received per contractsUtilize portals/fax/USPS to submit appeals for claim review when necessary. USPS should be last resort if portal/Fax unavailableProvide payor status updates when issues arise to leadership Review Sfax for documentation relating to payor groups dailyReview correspondence at the time of working denials to verify if we received essential information for the claim.Provide response to patient and client emails/voicemails within 24 business hours of receipt and document account appropriately Adherence to scheduleProductivity based on accuracy and qualityMaintain a positive, achievement-oriented attitude and influence others to do the sameDemonstrate high ethical standards and personal integrityDisplay a commitment to personal growthMINIMUM QUALIFICATIONSCollege degree preferred or equivalent but will substitute for applicable work experienceMinimum two (2) years’ experience in healthcare accounts receivable environment; knowledge of medical terminology, billing, and coding a plusDemonstrate proficiency in Microsoft Word and ExcelAdhere to Medicare, Medicaid Compliance and HIPAA guidelines in relation to PHI informationKNOWLEDGE, SKILLS, AND ABILITIESExceptional analytical and organizational skillsAbility to work independently, a team player with strong interpersonal skills to effectively interact with all levels of employeesSuperior time management and critical thinking skillsAbility to work under pressure and achieve goals efficientlyStrong written and verbal communication skillsDependable, flexible, and adaptable in all aspects of work SUPERVISORY RESPONSIBILITESNo direct supervisory responsibilities

Salary : $19 - $27