Reimbursement Specialist

Job Title: Reimbursement Specialist

Location: Plymouth, MN (Hybrid - 2 days onsite, 3 days remote)

Duration: 6 Months

Position Details:

We currently have a Reimbursement Specialist on approved FMLA leave of absence. To ensure continuity of operations and maintain productivity during this period, we are requesting a temporary Reimbursement Specialist to provide coverage while the employee is out.

The temporary resource will assist with daily reimbursement functions, including claim follow-up, denial management, payment posting support, account resolution, and maintaining aging and cash collection goals.

This coverage is necessary to prevent work backlogs, maintain service levels, support timely claim processing, and minimize the impact on key revenue cycle metrics.

The temporary position will be needed only for the duration of the employees’ leave and will help ensure business operations continue without disruption.

Job Responsibilities:

Core Responsibilities (80%)

• Responsible for the accurate and timely collecting of billed and unpaid DME claims related to Commercial, Federal, and State insurance plans and private pay accounts.
• Monitor and minimize aged accounts receivable; ensure follow-up on claims is within payer turn-around-time standards.
• Obtain and track claim status via phone and online portals.
• Monitor, take action, and respond to denials and claims-related correspondence.
• Compose and follow up on claims appeals within specified payer timelines and protocols.
• Appropriately identify, address, submit, or process adjustments, overpayments, and outstanding balances.
• Review and respond to payment information associated with Explanation of Benefits or Remittance Advice documents.
• Build relationships with insurance carriers and representatives.
• Update claims related to change of insurance.
• Review and release rental agreement holds.
• Communicate and collaborate with internal departments.
• Maintain strict confidentiality of patient personal information and maintain HIPAA compliance.
• Understand the business implications of decisions.
• Perform other duties as requested by the supervisor or manager.
• Processes, Procedures, and Systems (10%)
• Review, understand, and follow department policies, Standard Operating Procedures (SOPs), and job aides.
• Notify the Supervisor and Manager of any defects or enhancement opportunities for SOPs and job aides.
• Assist with the annual review of SOPs and job aides.
• Mentoring and Special Projects (10%)
• Assist peers in answering processing questions and assist in training new hires.
• Assume responsibility for reimbursement-related special tasks, projects, or assignments.
• Serve as a subject matter expert in the absence of the supervisor.
• Collaborate with external and internal team members and customers to create a positive experience, minimize days’ sales outstanding (DSO) and denials, and maximize cash collections.

Requirements:

• Minimum required Education: High School Diploma, Vocational Education.
• Minimum required Experience: Minimum 2 years of experience in Billing and Invoicing, Accounts Receivable/Payable, Contract Management or equivalent.
• Minimum required Certification: N/A