Reimbursement Specialist

Reimbursement Specialist

Reimbursement Specialist performs electronic and paper billing functions to submit claims. Performs computer edits and verifies data to ensure timely payment from the insurance carriers. Follow up with Medicare, Medicaid and/or Commercial payers regarding inappropriate discounts, unpaid claims, denials and questions regarding procedures.

Responsibilities

• Acts as a liaison between third-party payers and the organization.
• Answers telephone/mail inquiries dealing with patient's insurance carriers.
• Assists in other areas as requested.
• Billing and collections for all SBL service lines.
• Builds new and maintains existing contract terms in contract management system.
• Coordinate coding issues to assure accuracy with the coding compliance department.
• Develops and maintains routine payer audits at regular intervals.
• Ensures that reimbursement is maximized in accordance with payer contracts.
• Follow up with payers regarding inappropriate discounts, unpaid claims, denials, and questions regarding procedures.
• Identifies problem delinquencies and makes recommendations for their disposition (e.g., referral to collection agencies, write-off, etc).
• Process claims through billing system assuring the accuracy of claim information.
• Processes patient statements, chart documents, and patient demographics.
• Provides feedback on payer issues.
• Researches, identifies and corrects special circumstances affecting delayed payments of accounts.
• Researches contracting and payment issues and interacts with payers as a part of that process.
• Researches overpaid credits on patient accounts so that refunds can be made to the appropriate party in a timely manner.
• Responsible to understand and interpret reimbursement methodologies, billing and medical language so that effective and efficient analysis is provided.
• Review payment vouchers for adjustments that have not been completed or that are incorrect.
• Stay abreast of all government regulations by referencing publications, memos, websites, and attending seminars when offered.
• Stays informed of statutes and regulations, which could affect collection of receivables (e.g., insurance company changes, collection regulations, etc).
• Works variance work queues, identifying paper trends regarding the variance between actual and expected reimbursement for both facility and professional charges.

Requirements

• High School (Required)

Compensation

Estimated Compensation Range

$21.62 - $33.51

Pay based on experience