Reimbursement Specialist Medical Payment Reconciliation

Reimbursement Specialist - Medical Payment Reconciliation Specialist

Under the general supervision of the Director of Business Office Services, the Reimbursement Specialist - Medical Payment Reconciliation Specialist is responsible for managing patient balances, accurately and timely applying all insurance payments and adjustments to charges. The Medical Payment Reconciliation Specialist works closely with registration, billing, financial navigators and collection agency.

Essential Duties And Responsibilities

• Business Office Duties
  • Registers new patients, verifies coverage and obtains appropriate insurance and billing information, and updates information as needed.
  • Provides backup coverage for registration and financial navigation.
  • Explains billing policies/procedures and insurance benefits to patients.
  • Generates documentation for patients with private cancer insurance policies as needed.
  • Responds to patient inquiries (on-site visits and per phone), including researching relevant information.
  • Serves as a resource person for physicians, staff and patients/family/significant others regarding insurance and billing issues and questions.
• Reimbursement Duties
  • Monitors Self Pay balances, Establishes & Monitors Patient Payment Plans.
  • Reviews patient account to ensure monthly statements are mailed to the patient. Resolves returned mail. Monitors accounts of deceased patients and potential for filing probate claims.
  • Analyzes patient aged accounts. Reviews past due accounts, contacts patients to request outstanding balances. Pre-screens patient balances for collection agency placements. Reports unresolved accounts to the supervisor.
  • Places overdue accounts with collection agency. Monitors quality of data and account balances between EMR and Collection Agency.
  • Accurately and timely posts payments and adjustments, including checks, and credit cards from insurance, patients, and other organizations. Reviews EOBs and ERAs for payments and adjustments, posts payments and adjustments to corresponding charges.
  • Runs daily balancing reports and reviews/corrects discrepancies prior to day close procedures. Works offset and clearing accounts in a timely manner to eliminate balances in these transition accounts.
  • Works with billing team to locate missing remittances.
  • Researches overpayments and issues refunds as directed.
• Professional Communication
  • Maintains confidentiality in matters relating to all aspects of employment, including patient/family/significant other confidentiality.
  • Interacts with patients/family/significant others with a variety of developmental and sociocultural backgrounds.
  • Maintains professional relationships and conveys relevant information to other members of the health care team.
    • Internal Contacts: Physicians, nursing staff, laboratory staff, pharmacy staff, office staff, other Business Office staff, etc., and staff at other CCSI facilities.
    • External Contacts: Insurance representatives, Medicare representatives, coding specialists, hospitals, other physician offices, hospice staff, etc.
  • Relays information appropriately over telephones, facsimiles, e-mail, and other communication methods, and follows-through as needed.
  • Communicates appropriate information to physicians, supervisors, and/or other members of the healthcare team as needed, and follows-through on physician orders and requests.
• Teamwork
  • Works collaboratively as a health care team member.
  • Assists with tasks necessary for the general operation and organization of the Business Office.
  • Maintains positive attitude with patients, family/significant others and coworkers.

Professional Development

• Attends staff meetings and mandatory inservices.
• Participates in continuing education opportunities.
• Contributes to the quality of patient services and participates in quality improvement initiatives.

Other Duties

• Complies with all applicable safety and health regulations, policies and procedures. Complies with established personal protective equipment requirements necessary for protection against exposure to blood and body fluids, other potentially infectious material, chemical disinfectants, and other hazardous substances.
• Performs other duties as assigned.

Education/Qualifications

High school graduate or equivalent. Previous experience in medical office registration, billing, payment posting and or collections. Excellent attention to detail, problem solving and critical thinking. Working knowledge of Microsoft Word and Excel. Must take EPIC training and successfully pass required tests.

Knowledge/Skills/Abilities

General knowledge of basic manual and computerized accounting and billing systems. Excellent Math, Verbal and written English communication skills. Eye, hand, and auditory coordination. Basic computer skills. Problem solving and prioritization skills. Ability to work independently with minimal supervision and as part of a team; ability to work under pressure with time constraints; ability to meet deadlines and work with frequent interruptions; ability to concentrate, provide close attention to detail, and handle multiple tasks simultaneously. Ability to adapt to an individual's learning needs and requirements; ability to grasp billing system concepts and clearly explain their application; ability to demonstrate patience and support throughout learning experiences; ability to research and clarify system issues. Ability to maintain professional attitude at all times; ability to handle telephone and face-to-face contact with patients, physicians and other staff. Ability to function in a sometimes demanding and fast-paced work environment related to changing patient needs, including work with patients with acute, chronic, and complex disease processes and those who are dying. Understands and practices patient confidentiality. A positive attitude towards health care team members and diverse patient populations.

Physical Requirements Of Job

Standing, walking, sitting, carrying, pushing, pulling, lifting, bending, stooping, squatting, crouching, twisting, reaching, handling, kneeling, and wrist and digital dexterity. Involves significant degree of data entry. Involves significant degree of sitting, and involves standing or walking for brief periods of time. Speaking, hearing, and visual acuity to communicate with patients, physicians and other health care professionals; use telephone system; and operate office equipment and computers. Exerting force (frequently up to 10 pounds and occasionally up to 20 pounds or more) to lift, carry, push, pull or otherwise move objects, including office supplies, medical charts, billing forms, etc. Limited driving.

Mental Demands

Must be able to work under stress and adapt to changing conditions. Must be able to concentrate and focus on details. Must be able to prioritize requirements of the Reimbursement Specialist functions with additional training responsibilities.

Working Conditions

Normal medical office environment. Job duties involve minimal potential for exposure to blood and body fluids, chemical disinfectants, and limited exposure to chemicals such as cleaning disinfectants and toners for office equipment.

Benefits

• Health insurance
• HSA Option
• Dental insurance
• Paid Time Off (PTO)
• Sick Time
• Vision insurance
• 401(K) w/ match & profit sharing
• Life Insurance
• Short- & Long-Term Disability

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