Reimbursement Specialist

Reimbursement Specialist Job Summary The purpose of the Reimbursement Insurance Verification Specialist is to obtain and verify a client's commercial insurance coverage and to ensure procedures are covered by an individual's insurance. Specialist will be responsible for entering data in an accurate manner and updating client benefit information in the organization's billing system and verifying that existing information is accurate. The Specialist will perform a variety of auditing and resolution-centered activities, answering pertinent questions about coverage to internal and external sources, identifying insurance errors, and recommending solutions. Will be required to work regular office hours at the designated facility. This job description is not intended to be all-inclusive; and employee will also perform other reasonably related job responsibilities as assigned by immediate supervisor and other management as required. This organization reserves the right to revise or change job duties as the need arises. Moreover, management reserves the right to change job descriptions, job duties, or working schedules based on their duty to accommodate individuals with disabilities. This job description does not constitute a written or implied contract of employment. Job Description Employees in this job complete and oversee a variety of professional assignments to evaluate, review, enter, monitor, and update client insurance and billing information. Job Duties Analyzes designated eligibility reports on a daily basis. Communicates with and advises Insurance Verification Team Leader of all questions problems related to insurance verification. Adheres to all policies and procedures related to compliance with all federal and state billing regulations. Communicates with billing representatives regarding any insurance issues that may arise. Maintains a positive and professional attitude. Reads all emails and responds accordingly in a timely manner. Listens to all voicemails and respond accordingly in a timely manner. Works with members of various teams and/or departments on identifying process improvements. Possess flexibility to work overtime as dictated by department/organization needs. Assists in determining proper courses of action for resolution to insurance issues. Possesses problem-solving skills to research and resolve discrepancies, denials, appeals, collections. Possesses strong ability to think outside the box. Has the ability to work in a high stress/demanding environment. Performs additional duties as requested by Team Leads or Management Team. Job Qualifications Advance use of computer system, software, Excel, Outlook and Microsoft (word processing and spreadsheet application). Knowledge of Centricity is a strong plus. Knowledge of insurance guidelines including HMO/PPO, Commercial, Medicare, Medicare Advantage, TN Care's, Medicaid and Private Pay. Ability to work well in a team environment and alone. Being able to triage priorities, delegate tasks if needed, handle conflict in a reasonable fashion and analyze and resolve claims issues and related problems. Strong written and verbal communication skills. Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Knowledge of the center's Policies and Procedures. Ability to maintain records and prepare reports and correspondence related to the position. Ability to work directly with upper leadership regarding claims issues and resolutions. Possesses effective communication skills for phone contacts with insurance payers to resolve issues and to communicate effectively with others. Job Expectation All employees must be clean and well-groomed. Styles dictated by religion and ethnicity aren't restricted. Business casual dress code required. Employees can use their phones during breaks or at lunch hour. Employee must observe and be respectful of co-workers and should never use obscene, discriminatory, offensive, prejudicial or defamatory language in any way. The use of cameras on cell phones during work time is prohibited to protect the privacy of the clients as well as fellow employees, unless permission is granted by fellow employees or managers. Employees are permitted two 15-minute breaks and one hour lunch. Employees must work the agreed upon work schedule. Enter hours worked daily. Request leave in advance to your supervisor for approval. Schedule Monday - Friday 8am - 5pm Travel N/A Equipment/Technology Basic computer skills are required for email, timekeeping, scanning, and fax machine. Advance use of computer system, software, Excel, Outlook and Microsoft (word processing and spreadsheet application). Education High school diploma or equivalent required. Experience / Knowledge Extensive knowledge of insurance in relation to proper billing, follow-up and verification duties. Helen Ross McNabb Center is an Equal Opportunity Employer. The Center provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. This policy applies to all terms and conditions of employment. Helen Ross McNabb Center conducts background checks, driver's license record, degree verification, and drug screens at hire. Employment is contingent upon clean drug screen, background check, and driving record. Additionally, certain programs are subject to TB Screening and/or testing. Bilingual applicants are encouraged to apply. #J-18808-Ljbffr