Medical Billing Reimbursement Specialist

Zoll Data Systems - Lexington, KY

Full-time - Mid Level

Lexington, KY

Furniture, Home Furnishings, Electronics, and Appliance Retailers

About the position

This position is responsible for resolving aged accounts and managing denial claims in compliance with federal, state, and payor guidelines. The role requires expertise in Revenue Cycle Management and effective communication skills for interaction with colleagues, payors, and management. Experience in the ambulance transportation field is preferred.

Responsibilities

• Research and determine claim denials and take appropriate action for payment within federal, state, and payor guidelines.
• Identify consistent payor or system trends that result in underpayments, denials, errors, etc.
• Understand and navigate payor guidelines; escalate claim issues with payor when appropriate.
• Meet with leadership to discuss and resolve reimbursement and/or payor obstacles.
• Determine when an appeal, reopening, redetermination, etc. should be requested and take appropriate action to resolve claims.
• Use available resources such as payor portals and clearinghouses to review unresolved accounts.
• Identify unapplied payments and take appropriate action to resolve accounts.
• Call appropriate payors or patients to obtain necessary information to resolve claims.
• Obtain necessary information from appropriate sources to secure payment from payors, including medical records from treating facilities.
• Understand current medical insurance policies and procedures to determine claim resolution.
• Process or appeal refund requests following federal, state, and/or payor guidelines.
• Knowledge of HIPAA and multiple state guidelines to process attorney requests.
• Review eligibility responses and determine payor sequence; understand Medicare Part A vs Part B benefits and liability guidelines.
• Respond to written and verbal inquiries from patients regarding their accounts; process charity and payment plans following established policy.
• Maintain clear and concise communication both written and verbal, documenting all activities associated with an account.
• Meet company production and quality standards while working in a fast-paced environment.

Requirements

• Minimum 3 years in medical reimbursement field.
• Ability to read and understand Explanation of Benefits (EOBs).
• Proficient in MS Excel (filtering and formatting reports).
• Proficient in MS Word (formatting letters and templates).
• Experience with PDF formatting and editing in Adobe Acrobat or equivalent.
• High School diploma or GED equivalent; some college-level courses preferred.
• Ability to confidently communicate with insurance representatives and patients.
• Experience in billing 1500 and UB04 claim forms.
• Understanding of non-contracted and contracted payer behaviors.
• Ability to interact professionally at all levels.
• Typing speed of 45 wpm; proficient in 10-key by touch.
• Knowledge of medical terminology.
• Ability to operate office equipment.
• Must provide documentation to support ability to work in the United States within federal legal guidelines.

Nice-to-haves

• Experience in the ambulance transportation field.

Benefits

• Innovative technologies that improve patient outcomes.
• Opportunities for professional development and growth.
• A culture that values innovation and self-motivation.