Medical Billing Reimbursement Specialist

ZOLL Medical Corporation - Broomfield, CO

Full-time - Mid Level

Broomfield, CO

10,001+ employees

Merchant Wholesalers, Durable Goods

About the position

This position is responsible for resolving aged accounts and managing denial claims in the medical reimbursement field, particularly within the ambulance transportation sector. The role requires professional communication skills for effective interaction with colleagues, payors, and management, and involves navigating complex payor guidelines to ensure timely payment and resolution of claims.

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 to escalate claim issues when appropriate.
• Meet with leadership to discuss and resolve reimbursement and/or payor obstacles.
• Determine when an appeal, reopening, or redetermination 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 for claim resolution.
• Obtain necessary medical records from appropriate sources to secure payment from payors.
• Understand current medical insurance policies and procedures to determine claim resolution.
• Process or appeal refund requests following federal, state, and/or payor guidelines.
• Process attorney requests while adhering to HIPAA and multiple state guidelines.
• Review eligibility responses and determine payor sequence, including knowledge of Medicare Part A vs Part B benefits.
• Respond to written and verbal inquiries from patients regarding their accounts and process charity and payment plans as per established policy.
• Maintain clear and concise communication, documenting all activities associated with an account.
• Meet company production and quality standards while working in a fast-paced environment.

Requirements

• Minimum 3 years of experience in the 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, with 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 and proficiency in 10-key by touch.
• Knowledge of medical terminology.
• Ability to operate office equipment.

Nice-to-haves

• Experience working in the ambulance transportation field.
• Knowledge of HIPAA and multiple state guidelines for processing requests.

Benefits

• Health insurance coverage.
• Professional development opportunities.
• Flexible scheduling options.