What are the responsibilities and job description for the Insurance Reimbursement Specialist position at ROUND TABLE MEDICAL CONSULTANTS LLC?
The Insurance Reimbursement Specialist is responsible for the collection, follow-up, and appeals of insurance claims. Essential to this position is the ability to manage all insurance follow-up for maximum insurance reimbursement. To include outbound and inbound insurance carrier calls, reprocessing claims, drafting appeals, working denials, and resolving unpaid claims.
Qualifications:- High school diploma or GED required.
- Minimum of three years of experience in medical insurance follow-up, collections, denial management, and reimbursement.
- Knowledge of both in-network and out-of-network facility and professional claims.
- Experience working with commercial insurance carriers, including UHC, Cigna, Aetna, BCBS, Marketplace plans, workers’ compensation, and third-party liability claims, is preferred.
- Strong knowledge of claim status follow-up, denial resolution, corrected claims, reconsiderations, and appeals.
- Ability to read, analyze, and interpret EOBs, ERAs, payer correspondence, denial codes, and reimbursement information.
- Proven experience preparing and submitting appeals in a high-volume claims environment.
- Experience working in a production-based environment and consistently meeting productivity, accuracy, and quality expectations.
- Strong verbal and written communication skills.
- Ability to clearly communicate claim issues, reimbursement discrepancies, and appeal requests to insurance representatives.
- Excellent analytical, problem-solving, research, and negotiation skills.
- Ability to prioritize assignments, manage multiple deadlines, and work independently with minimal supervision.
- Positive attitude and demonstrated ability to collaborate effectively with team members and leadership.
- Knowledge of EPOWERDOC and Centricity is preferred.
- Proficiency with Microsoft Windows, Excel, Word, payer portals, and other medical billing applications.
- Ability and willingness to learn new software, payer systems, and reimbursement processes.
- Typing speed of 45–60 words per minute preferred.
JOB RESPONSIBILITIES/DUTIES
• Work assigned claims accurately, efficiently, and within established departmental and corporate timeframes.
• Understand and stay informed of changes to procedures, billing guidelines, and laws for specific insurance carriers or payers.
• Research claim status, payment discrepancies, denials, coding or billing issues, authorization concerns, eligibility problems, and payer-specific requirements.
• Actively follow up and collect on all claims, including resolution of any billing errors following established procedures.
• Follow all departmental policies, standard operating procedures, compliance requirements, and leadership directives.
• Protect patient information and comply with HIPAA and all organizational confidentiality requirements.
• Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction, and attendance.
• Perform other duties as assigned by department manager.
WORKING CONDITIONS
• Frequent speaking, listening, using a headset, use of hands/fingers across keyboard or mouse, handling other objects, and long periods working at a computer.
• Service center with moderate noise level due to representatives talking, computers, printers, and floor activity.
• While performing duties of this job, the employee is frequently required to stand, walk, and sit.
• Must submit to random drug screenings.
Full-Time Benefit Perks:
- Health benefits start on the first of the month after hire
- Medical, dental, and vision plans with sliding-scale premiums
- 100% coverage for preventive health services
- HSA and FSA options available
- Company-paid life insurance and long-term disability
- 401(k) with contributions starting after 30 days
- 100% match on the first 4%,
- Full vesting after 3 years
- Access to exclusive employee discounts on travel, fitness, shopping, and more
- Paid Time Off
- Paid Holiday
Join us and make a significant impact on our company’s success in reaching our target audience and driving business growth.
Salary : $19 - $24