Medical Reimbursement Technician

Job Title

This is not a virtual position, you must live within or be willing to relocate within a commutable distance of the duty location. This position involves a multi-grade career ladder. Promotion is at the discretion of the supervisor and is contingent upon satisfactory performance, availability of higher level work, and availability of funds.

Major Duties and Responsibilities

Major duties and responsibilities include:

• Verifying veterans' insurance coverage for inpatient and outpatient services, entering updated information, and maintaining the database.
• Documenting pre-admission requirements and identifying patients requiring second opinions.
• Responsible for all reimbursable billing activities including consideration of professional services and facility services, sharing agreements, Tricare, Champ VA, Medicare, and pharmacy billing.
• Validating claims for billing purposes ensuring eligibility and referring questionable coding for review; monitoring reports to assure all possible billable cases are processed; and ensuring proper sequencing of diagnostic and procedural codes and assigns modifiers as needed.
• Responsible for third party collection from insurance companies and for accounts receivable including humanitarian, DoD, Tricare tort feasor, workman's compensation, fugitive felon, ineligible Champ VA, and no-fault auto accidents.
• Researching and resolving problems and posting payments, adjustments, denial codes, and non-payment collections.
• Following up on accounts receivable; determining the accuracy of reimbursement received; responding to correspondence and inquiries; expediting and maximizing collections; maintaining records; and making debt adjustment and assigning funds received to the correct account.
• Verifying the accuracy of payments, resolving problems and discrepancies, and closing out accounts.
• Responding to questions and inquiries from veterans and insurance companies.
• Auditing accounts, ensuring payments recovered by insurance carrier are posted in a timely manner to the veterans Category C bills.
• Performs other duties as assigned.

Work Schedule: Monday-Friday 8:00am-4:30pm

Recruitment & Relocation Incentives: Not authorized

Critical Skills Incentive (CSI): Not approved