Reimbursement Specialist

Description:

This is to cover for an employee who is out on leave, expected duration is 6 weeks. 

Actual Job Title is Reimbursement Specialist 

Experience: 2-5 years of experience in position or specialization. Education: High-school/Associates or equivalent experience if applicable. Certification if applicable. 

Position Summary: 

The Reimbursement Specialist is responsible for the accurate and efficient billing and collecting of payments from insurance carriers, third party agencies and patients. The Reimbursement specialists will coordinate, document, and communicate with health insurance representatives and patients in regards to proper insurance payments in accordance with policies and procedures, and current federal, state and local and standards, guidelines, and regulations 



Responsibilities (80%) 
• Responsible for accurate billing and collecting of revenue for financial classes including Commercial, Federal and State insurance plans and private pay accounts. 
• Obtain and track claim status via phone and online portals. 
• Compose and follow up on claims appeals 
• Appropriately identify, address, submit or process adjustments, overpayments, and outstanding balances. 
• Review and respond to payment information associated with Explanation of Benefits or Remittance Advice documents. 
• Build relationships with insurance carriers and representatives. 
• Allocating coinsurance and deductible appropriately within the database. 
• Responsible for reviewing and addressing incoming mail correspondence. 
• Communicating with patients regarding outstanding balances. 
• Communicate and collaborate with the internal departments. 
• Maintains strict confidentiality of patient personal information. 
• Maintains HIPPA compliance. 
• Understands business implications of decisions. 
• Performs other duties as requested by supervisor or manager. 

Processes, Procedures and Systems (10%) 

 Reviews, understands and follows department policies, Standard Operating Procedures and job aides. 
 Notifies Supervisor and Manager of any defects or enhancement opportunities for SOP’s and job aides. 
 Assists with annual review of SOP’s and job aides.

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