Reimbursement Specialist I

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Description

Job Summary/Job Purpose:

The Reimbursement Specialist I effectively reviews and processes paperwork necessary to bill and collect fees for equipment and services provided. In this role, you will interact with patients, referral sources, hospitals, physicians, insurance companies, state and federal agencies, as well as third-party intermediaries to complete transaction processes.

Job Duties / Essential Functions

• Educate patients and staff regarding payer coverage, eligibility guidelines, documentation requirements and insurance change.
• Maintains an extensive knowledge of different payer coverage, insurance policies, payer guidelines and payer contracts ensure accurate billing and timely payment is received.
• Handle all insurance payer disputes
• Identify trends and root causes related to inaccurate insurance billing
• Review work lists and daily claims to ensure accurate claims are submitted. Make edits as needed.
• Complete assigned accounts receivable projects within the required timeframes to ensure proper billing and timely filing.
• Identify unpaid claims by patient and payer. Implement necessary corrective action on each unpaid claim.
• Rectify daily denials by correcting issues, making appropriate adjustments within the system, and resubmitting when resolved. Provide detailed documentation of patient denials.
• Communicate with insurance companies regarding denied or unpaid claims to determine explanation and corrective action. Appeal claims denial with specific insurance payers.
• Update changes to specific patient insurance policy and registration information.
• Answer patient billing questions coming in through the phone queue.
• Accurately enter all data into the computer system as required.
• Review and complete all Brightree tasks within three business days.
• All other duties as assigned.
  
  

Requirements

Skills / Qualifications:

• High School Diploma or GED.
• Minimum 1 year experience in similar medical collections/billing role or business-related field.
• Excellent time management and organizational skills.
• Proficient in MS Office with proven data entry experience.
• Ability to communicate with the patient and all members of the health care team.
• Knowledge of Payor/Insurance benefits preferred.
  
  

Physical Requirements / Working Conditions

• These are physical and mental requirements of the position as it is typically performed. Inability to meet one or more of these physical or mental requirements will not automatically disqualify a candidate or employee from the position.
• Upon request for a reasonable accommodation, the Company may be able to adjust or excuse one or more of these requirements, depending on the requirement, the essential functions to which it relates, and the proposed accommodation.
• Sitting for extended periods of time.
• Manual dexterity for typing and writing.
• Ability to read small print and view a computer screen for prolonged periods.
• Ability to lift, push, pull, or carry objects up to 20 pounds.
• Able to wear over-ear headsets for majority of workday.