Reimbursement Specialist

Job Full Description

Position Summary:

To accurately prepare claims for submission to outside payer sources and collect appropriate reimbursement for all services rendered.


Minimum Qualifications:

High School Graduate or equivalent. Excellent interpersonal and customer relation skills are necessary. Candidate should have strong organizational ability, detail oriented; possess problem solving skills and the ability to work independently. Must be competent in operating a computer, scanner, typing and using the telephone. Working knowledge of Microsoft applications including Excel, Word, Outlook and PowerPoint preferred.

Preferred Qualifications:


Previous Infusion Reimbursement or Intake/Admissions experience

Job Description Summary:

Process claims and invoices

Job Responsibilities:

1. Submits timely, accurate invoices to payer for products and services provided. • Correctly determines quantities and prices for drugs billed. • Verifies that the services and products are correctly authorized and that required documentation is on file prior to billing. • Ensures that invoices are submitted for services and products that are properly ordered and confirmed as provided. • Ensures that all required documentation for billing is completed and accurate prior to claim submission. • Adheres to Regulatory / Payor Guidelines and policies & procedures

1. Claims and invoices are to be processed daily and billed out to the insurance carrier on the first possible date the insurance company will accept an electronic claim. If a paper claim is necessary, the claim will be billed out within 5 days of the end date on the claim. All outstanding claims will be processed by the 5th business day following the end of the month.

1. Review Daily Deposit Folder for payments and denials on a daily basis. For Medi-Cal/CCS and CCA, Remittance Advice Detail denials should be addressed and completed before the next check run; usually within 1 week.

1. Generate secondary insurance claims and patient co-pay invoices daily. Patient co-pay invoices will be mailed out upon receipt of payment with a copy of the Explanation of Benefits. Monthly statements will be mailed out to patients on or about the 5th of each month.

1. Follow up on Patient Statements monthly with a personal phone call if payment has not been received. Each correspondence/conversation should be noted on the Patient Account Status Screen with a Billing Follow Up note documenting record of the follow up.

1. Billing Follow Up will be up to date within 5 days of Follow Up Date.

1. Review all accounts greater than 90 days for status and follow-up using the Billing Follow Up tool and the A/R Manager.

1. Respond to outside correspondence (both written and verbal) appropriately and timely. (Preferably within 7 days of receiving correspondence)

1. Document and submit invoice adjustments through software TO DO's as necessary for Manager approval of invoice adjustments.

1. Document and submit refund requests for patient accounts as necessary for Manager approval.

1. Prepare special projects for Manager as requested.

1. This job description is to be used as a guide for accomplishing Company and department objectives, and only covers the primary functions and responsibilities of the position. It is in no way to be construed as an all-encompassing list of duties.

Apply Now!

• Give our office a call: View phone number on click.appcast.io and press 2
• Stop by our office:
• Visalia - 4002 S. Demaree Visalia, CA 93277
• Fresno - 7411 North Cedar Avenue Fresno, CA 93720

Location: Visalia, CA


Position Type: Full Time; Evaluation to Hire

What Makes Express Employment Professionals Different?


Express Employment Professionals is a local employment agency that has been helping people find great jobs in the Visalia-Fresno area since 2007. We focus on helping people find permanent, long term positions at some of the best companies in the area. Every week we are actively working with 130+ companies in Mid-Valley.


Express has a wide variety of jobs available, including:

• Light Industrial
• Skilled Trades
• Administrative
• Professional

Benefits of working with Express:

• Weekly Pay
• Medical, Dental, Vision, Short-Term Disability, and Life Insurance
• 401(K) Savings Plan
• Holiday and Vacation Pay
• Scholarship programs
• Free Online Training

Apply today on the ExpressJobs app! Search for other great job openings in your area, build your profile, and apply, all from your mobile device. Available in the or .

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Visalia, CA
2433
4002 South Demaree
Visalia, CA 93277