Reimbursement Specialist

Reimbursement Specialist

Performs a variety of AR activities and related tasks in order to recognize the maximum reimbursement from each claim. This position will be responsible for navigating the electronic medical record (EMR) and billing systems to obtain/produce and transmit the records required by the applicable insurance carrier or third party. Demonstrates understanding of explanation of benefits (EOBs) and ability to digest and respond appropriately to denials and correspondence. Clear and concise notation/documentation is paramount to success in the role.

Join MPOWERHealth as a Reimbursement Specialist Where Your Skills Drive Healthcare Forward! Are you a natural problem-solver who thrives on turning challenges into opportunities? Do you enjoy collaborating with a passionate team and making a direct impact on healthcare providers' success? If so, your next great opportunity is here at MPOWERHealth!

For over a decade, MPOWERHealth has empowered independent musculoskeletal physicians with cutting-edge clinical services, back-office solutions, and advanced technology. We simplify the complex, anticipate challenges, and guide our clients toward a brighter future. With our innovative analytics and expert teams, we transform obstacles into opportunities.

Responsibilities

Understand and comply with all governmental, regulatory, company billing/AR and compliance regulations/policies assigned by payers

• Analyze EOBs and construct responses to insurance carriers based on claim adjudication.
• Follow up with payers and other appropriate parties to collect open balances in a timely manner and to ensure compliance with payer guidelines
• Identify and report payer issues regarding rejection trends, denial trends, or change in payments. Communicate specific payer information to appropriate parties/departments
• Address denials and zero payments to identify and provide any requested documentation required to process the claim or refer to billing for claim corrections
• Follow up and complete tasks on pending accounts in a timely manner until account is settled.
• Use of office equipment and software applications to facilitate finalization of claim

Qualifications

High school diploma or GED equivalent required.

• 2+ years of medical collections experience required.
• Intermediate level of expertise using Microsoft Office Suite (Outlook, Excel, Word, Teams) and PDF software (NitroPro)
• Familiarity with insurance payer rules and regulations
• Ability to affectively multi-task
• Strong comprehensive and analytical skills
• Effective verbal and written communication skills including professional phone skills
• Detail-oriented.
• Able to function as a cooperative team member with a positive attitude.
• Must have ability to work independently with minimal supervision and maintain confidentiality.

Previous experience working with multi-state practices.

Previous out of network experience