Reimbursement Specialist I

Position Summary


The Reimbursement Specialist is a pivotal position requiring excellent communication skills, independent judgment, and ability to interact with private, state and federal payer representatives, fiscal intermediaries, case managers, pharmacy partners and nufactor field personnel in the role of coordinating reimbursement from product dispensing through to completion and final resolution of the payment cycle.


Incumbent shall possess basic knowledge of reimbursement principles as well as the structure of various private, federal and state payer entities and the specific program issues related to each.


Essential Functions and Duties

• Submit and/or follow-up on payer claims. This may include; primary, secondary, tertiary claims and/or patient statements. Verify accuracy of payments according to the payer's fee schedule.

• Possess a basic understanding and ability to audit accounts receivables: analysis of payments, contractual discounts and/or adjustments, bad debt, recoupments, refunds and the credit/debit function.

• Draft professional, concise cover letters, appeals and correspondence. This may include provider dispute forms, re-openings, reconsiderations, and various levels of appeals as necessary during the collection process.

• Resolution of credit balances. This may include revenue adjustments, balance transfers, recoupments and/or refunds.

• Clearly and accurately document all collection efforts within the AR system. Complete and submit monthly claim status reports.

• Promptly inform management of reimbursement rates, changes, and/or issues which may directly affect nufactor receivables.

• Maintain reimbursement records in compliance with nufactor policies & procedures.

• Attend and participate in departmental meetings. Continuously strive to improve processes and service quality to internal and external customers.

• Attend pertinent job-related trainings and educational seminars.

• Conduct special projects as requested by management.

• Supports all reimbursement activities related to a revenue base representing approximately $200 million per year and a projected DSO of less than 40 days.

• Adheres specifically to all company policies and procedures, Federal and State regulations and laws.

• Display dedication to position responsibilities and achieve assigned goals and objectives.

• Represent the Company in a professional manner and appearance at all times.

• Understand and internalize the Company's purpose; Display loyalty to the Company and its organizational values.

• Display enthusiasm and dedication to learning how to be more effective on the job and share knowledge with others.

• Work effectively with co-workers, internal and external customers and others by sharing ideas in a constructive and positive manner; listen to and objectively consider ideas and suggestions from others; keep commitments; keep others informed of work progress, timetables, and issues; address problems and issues constructively to find mutually acceptable and practical business solutions; address others by name, title, or other respectful identifier, and; respect the diversity of our work force in actions, words, and deeds.

• Comply with the policies and procedures stated in the Injury and Illness Prevention Program by always working in a safe manner and immediately reporting any injury, safety hazard, or program violation.

• Ensure conduct is consistent with all Compliance Program Policies and procedures when engaging in any activity on behalf of the company. Immediately report any concerns or violations.

• Other duties as assigned.

Education, Knowledge, Skills and Experience


Required Education:

• High school diploma or equivalent required.

Required Knowledge:

• Basic knowledge medical reimbursement principles.

• Intermediate to advanced Microsoft Office skills. Basic to intermediate understanding of Internet technologies, including payer portals.

Required Experience:

• Three (3) years health care related experience i.e. DME, home care, medical insurance, or medical case management.

Preferred Experience:

• Pharmacy or home infusion experience preferred.

Required Skills:

• Excellent verbal and written communication skills, along with the ability to interact effectively with customers, coworkers, and all levels of management.

• Ability to effectively communicate with all levels of personnel within the payer realm, including proficiency in accessing the appropriate personnel to resolve problem claims.

• Ability to make independent judgments and work with minimal supervision.

• Strong organizational skills and detail oriented with the ability to manage multiple assignments and responsibilities. Ability to prioritize work, work effectively, and maintain expected productivity.

• Ability to exercise discretion and maintain confidentiality to the level of required HIPAA standards.

Physical requirements


Vision, hearing, speech, movements requiring the use of wrists, hands and/or fingers. Must have the ability to view a computer screen for long periods and the ability to sit for extended periods. Must have the ability to work the hours and days required to complete the essential functions of the position, as scheduled. Must have the ability to lift and maneuver items of at least 20 lbs. Working condition include normal office setting.


Mental Demands


Learning, thinking, concentration and the ability to work under pressure, particularly during busy times. Must be able to pay close attention to detail and be able to work as a member of a team to ensure excellent customer service. Must have the ability to interact effectively with co-workers and customers, and exercise self-control and diplomacy in customer and employee relations' situations. Must have the ability to exercise discretion as well as appropriate judgments when necessary. Must be proactive in finding solutions


Direct Reports


No


EEO Statement


FFF Enterprises and Nufactor are an equal opportunity employer and prohibits discrimination and harassment based on the following characteristics: race, color, religion, national origin, physical or mental disability, gender, age (40 years and over) qualified veteran and any other characteristic protected by state or federal anti-discrimination law covering employment. These categories are defined according to Government Code section 12920. The Company prohibits unlawful discrimination based on the perception that anyone has any of those characteristics or is associated with a person who has or is perceived as having any of those characteristics.