Description

Job Summary

The Revenue Reimbursement Specialist works to ensure that we are optimizing insurance

collections, reducing outstanding balances, and maintaining the accounts receivables. Revenue

Reimbursement Specialists will maximize reimbursement for all services while minimizing the

amount of time it takes to obtain reimbursement; decrease AR sustain a low DSO.

Responsibilities

• Communicate directly with the payor, resubmits denied claims, underpaid claims and claims that are inaccurately processed by auditing accounts to check on proper payments, coding, balances, adjustments, etc. using appropriate reports and queues
• Review and analyze claim denials in order to perform the appropriate appeals necessary for reimbursement
• Manage outstanding accounts receivable for assigned payers/Divisions
• Resolve outstanding balances
• Follow up on outstanding accounts receivables, 31-60 days, 61-90 days. Includes
• researching aged account reports, outstanding “list”, processing problematic
• EOB’s and/or incoming mail or correspondence as identified
• Special projects on 90 days detailing problematic accounts and reporting them to the supervisor
• Identify errors, correct and communicate to management
• Additional Responsibilities: Conduct random audits to verify system integrity, payer accuracy and payment
• per contract, to optimize reimbursement functions
• Other duties as assigned

Requirements

Skills and Competencies

• Accounts Receivable knowledge: ability to read, analyze and interpret EOB’s and other AR procedures
• Adheres to organizational policies and procedures, including Corporate Compliance Program, HIPAA regulations.
• Knowledge of Medicare, Medicaid, HMO/PPO/EPO, Work Comp and Commercial Insurance operating procedures
• Ability to effectively correspond and interact with insurance payers, co-workers,
• management both verbally and in writing.
• Detail Oriented with organizational and problem-solving skills.
• The ability to work in a fast-paced environment

Requirements/Qualifications

• High School Graduate
• Minimum 2 years’ experience in Healthcare Revenue Cycle
• Strong problem-solving skills and the ability to make timely decisions
• Knowledge of Federal, State and third-party payor reimbursement rules and regulations
• Certified Coder preferred, but not required