Reimbursement Specialist

Billing & Reimbursement Specialist I

Ideal candidate - Performed Accounts Receivable (AR) follow-up on denied, unpaid, and underpaid claims, rejections, collections, Explanation of Benefits (EOB), claim edits, and secondary billing. THIS IS A FULLY REMOTE POSITION! The Billing & Reimbursement Specialist I is assigned a group of dialysis facilities and is responsible for the accurate and efficient billing and collecting of health insurance payments from insurance carriers. The Billing & Reimbursement Specialist coordinates, documents, and communicates with health insurance representatives regarding proper insurance payments in accordance with policies and procedures and current federal, state, and local standards, guidelines, and regulations.

Essential Functions

• Responsible for accurate billing and collecting of revenue for respective financial classes
• Demonstrates a higher knowledge of respective financial class
• Obtains and tracks claim status via phone and online portals
• Composes and follows up on claims appeals
• Appropriately identifies, addresses, submits and processes adjustments
• Reviews and understands Explanation of Benefits documents
• Builds effective working relationships with insurance carriers and representatives
• Allocates coinsurance and deductibles timely and appropriately within applicable database
• Effectively collects and/or resolves a higher volume of claims and more difficult accounts
• Actively applies a solid foundation and knowledge of Billing and Reimbursement practices while exercising appropriate independent thought and decision-making skills to effectively troubleshoot and offer guidance on next steps

Submission Requirements

• 5+ years experience with collections and claims follow up - REQUIRED
• Experience with full revenue cycle, specifically Medicare and Veterans Affairs reimbursements - REQUIRED
• Must have a strong background in claim resolution (claims follow up/denial management) - REQUIRED
• Must understand how to identify high priority areas of claims aging and be self-motivated/independent - REQUIRED
• Bachelor's degree with a focus in business or healthcare management - REQUIRED
• Knowledge of Excel, PivotTable and VLOOKUP - REQUIRED
• Proficiency in Microsoft Office Suite - REQUIRED
• Dialysis or healthcare experience - REQUIRED
• Must be Bilingual (Spanish/English- other languages are a plus) - REQUIRED

Interview Expectations:

• Interviews are conducted via TEAMs and camera must be turned on at all times.
• Interview may be with more than one Supervisor/Manager

About the Facility

Innovative Renal Care (IRC) is one of the largest dialysis service providers in the United States. We provide quality patient care to patients suffering from the most advanced state of chronic kidney disease, known as End Stage Renal Disease (ESRD). We continue to expand our network of dialysis centers and improve more lives each year. Apply to become part of a team who is focused on quality patient care! OT/Holiday - 1.3x BR 0 hours non-billable