Description

Position Summary

The role of the Medical Reimbursement Specialist reports to the Director of Billing & Admissions, in partnership with the Dialysis CEO/Administrator. This position is responsible for for analyzing insurance documents, processing reimbursement claims, and releasing accurate billing statements for insurance claims. This position must possess excellent analytical skills, especially on performing clerical tasks to evaluate insurance cases, investigate cases, and update account information accordingly. This position must also possess consistent and effective communication skills and understanding of the insurance process in order to coordinate with the clients, explain procedures for claims accurately, and manage the insurance process for maintenance and improvement.

Essential Position Responsibilities

• Coordinate and manage resources, including primary and secondary third-party payers.
• Obtain precertification and prior authorization for required medical services from third party payers.
• Maintain a professional and confidential working environment.
• Explain insurance benefits, policy requirements, and filing rules to patients.
• Research and apply knowledge of all insurance rules and regulations for major insurance programs in the local or regional area.
• Input and maintain patient data into appropriate database and ensure accuracy.
• Ensure client confidentiality and compliance with HIPAA regulations.
• Determine the protocol that identifies a responsible party’s monetary responsibility in health insurance claims.
• Verify all patients insurances.
• Obtain Authorizations as required by insurance carriers.
• Collect all Co-pays, Coinsurance and Deductibles.
• Back up for Medical Reimbursement Specialist II and Prior Authorization Specialist.
• Other duties as assigned

Qualifications

• Education: High school diploma or GED, required
• Licensure and Certifications: Certificate in Medical Coding and Billing or a Certified Medical Reimbursement Specialistpreferred
• Experience: Minimum of 3 years of medical office experience. Experience with working with third-party resources, including Medicare, Medicaid and private insurance, required. Previous insurance benefits, medical records and patient registration, required.

Qualifications