This position requires an advanced understanding of records, coding, and billing practices to ensure compliance and patient confidentiality. If you want to be in a medical setting where you don’t have to be up and running, becoming a reimbursement specialist may be the right career for you. If you have been in a previous insurance role and have strong organization skills, you may be the perfect candidate to fulfill our open position as a reimbursement special

This position performs moderately complex bookkeeping, recordkeeping, and insurance claim billing activities. Responsibilities include payment posting, work denials and appeals for Medicaid, Medicare, Managed Care Organizations and Private Insurance. Attends required training and meetings.

Duties and Responsibilities:

• Performs routine inquiries to include eligibility and verification of benefits, obtaining financial information, maintaining accounts, collecting charges for the support or treatment provided to clients.
• Submits timely, accurate invoices to payer for products and services provided. Understands the terms and fee schedule for all contracts for which invoices are submitted. Verifies that the services and products are correctly authorized and that required documentation is on file. Ensures that invoices are submitted for services and products that are properly ordered and confirmed as provided.
• Evaluates payments received for correctness and applies payments accurately to the EHR system. Verifies that payments received are correct according to the fee schedule. Applies payments correctly to client accounts. Notifies the Reimbursement Manager if there are overpayments and/or duplicate payments for the same service.
• Understand insurance carrier guidelines and coverage rules; stay abreast of changes and communicate to management and staff.
• Investigate denied claims in a timely manner including coordinating with clinical staff, to ensure that invoicing is accurate. Understands when claims should be corrected and refiled and when appeal packages must be submitted to collect the maximum revenue allowed.
• Monitor A/R reports and process corrected claims, adjustments, or write-offs in EHR.
• Prepare monthly reports for management team on status of client/payer accounts worked.
• Ensures compliance with policies and guidelines outlined in the contract terms and fee schedule. Follows HIPAA guidelines when accessing and sharing patient information to maintain patient and business confidentiality.
• Other duties as assigned by Revenue Cycle Management team

Education and Experience:

• High School Diploma or GED, plus two years related work experience required. Must have a valid Texas driver’s license and acceptable driving record, as well as personal automobile liability insurance as required by the State of Texas.

Preferred Qualifications: Five or more years of work experience processing insurance claims for health-related accounts and collection work.

Knowledge, Skills & Abilities:

• Ability to work in a team environment, effective communication skills, and a commitment to customer satisfaction
• Professionalism, accuracy, dependability, and confidentiality are essential
• Ability to examine documents for accuracy and completeness and prepare claims and other records according to detailed instructions
• Must be able to work independently and prioritize multiple tasks

Work Schedule: 8-5 (Mon-Fri) Flex

Salary Range: $18-$22 (Depending on Experience/Qualifications)

Employee Benefits at Full-Time Include:

• Employer-Cost Sharing of Health Insurance (Plus 50% of Elected Dependent Coverage)
• Employer-Paid Short-Term Disability Insurance
• Loan Forgiveness Program
• Employee Assistance Program
• Pet Insurance
• Employer-Paid Term Life Insurance
• Employer-Match Retirement Contributions (Up to 5% of Base Salary)
• Optional Dental, Vision, Life and Long-Term Disability Insurance
• Wellness Program
• 12 Paid Holidays per Year
• 2 Weeks of Paid Vacation Leave per Year with Graduating Accrual Rate
• 2 Weeks of Paid Sick Leave per Year

Experience

• 2 year(s): Required related work experience listed above.

• 3 year(s): Preferred Experience: Five or more years work experience processing insurance claims for health-related accounts and collection work.

Education

• High School or better