Account Reimbursement Specialist II

Job Summary The Account Reimbursement Specialist II demonstrates a thorough understanding of medical office billing‑related functions. This role will closely monitor and analyze payor denial trends, perform claim corrections, and perform timely claim follow‑up by submitting appeals and claim reconsiderations to ensure maximum payor reimbursement. This role is vital to the overall financial success for the organization. This is a full‑time position that will support the RCM team Monday - Friday 8 am to 5 pm. Primary Job Responsibilities Ability to perform all responsibilities of ARS I position Acts as point of contact for assigned department(s) for incoming questions regarding third‑party billing requirements, denials, and patient‑related billing inquiries. Coordinates with RCM team partners responsible for charge capture, coding, reimbursement and/or insurance verification to identify and resolve issues impacting billing and collections. Pursues timely collection of insurance claim payments using thorough follow‑up efforts appropriate for each payor type (including denials, appeals, exceptions, exclusions) Review and interpret insurance explanation of benefits (EOBs) to ensure correct claim reconciliation. Filing appeals when appropriate to obtain maximum payor reimbursement. Analyzes trends in under/overpayments and payment denials and works collaboratively to develop process improvements meant to improve RCM operations and reduce costs. Coordinate medical records requests; process all insurance and patient correspondence to ensure compliance with all relative reporting and data collection regulations. Perform patient and insurance payor outreach to research and resolve payment‑related inquiries for Athena patient cases. Work collaboratively with clinic managers and other RCM department staff to improve processes and procedures Participate in department workgroups providing feedback and education on claims activities (payer denials, system issues, etc) Additional duties as assigned Requirements Minimum of three (3) years of complex claim follow‑up experience in a physician office, hospital, ambulatory surgery center or centralized medical business office Knowledge of HMO/PPO, Medicare, Medicaid, and other payor regulations, payment guidelines, and policies Knowledge of medical terminology, ICD‑10, and CPT codes Excellent verbal communication skills Excellent computer skills; familiarity with Microsoft Word & Excel. Experience with AthenaHealth EMR is a plus. Ability to manage time and organize daily schedule to meet productivity and accuracy standards. Experience interpreting payor explanation of benefits. Excellent verbal communication skills and strong customer‑service background. Education and Certifications High school diploma or equivalent required Associate degree in business, healthcare administration or related field highly preferred. Physical Requirements Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling Must be able to lift and support weight of 35 pounds. Ability to concentrate on details Use of computer for long periods of time #J-18808-Ljbffr Tryon Medical Partners