Medical Billing-Reimbursement

About the position

The Reimbursement Specialist plays a crucial role in managing the reimbursement process for medical billing, requiring strong communication skills and independent judgment. This position involves coordinating with various payer representatives and ensuring accurate claims submission and follow-up, ultimately supporting the company's revenue cycle management.

Responsibilities

• Submit and follow-up on payer claims including primary, secondary, and tertiary claims.
• Verify accuracy of payments according to the payer's fee schedule.
• Audit accounts receivables including analysis of payments, contractual discounts, and adjustments.
• Draft professional cover letters, appeals, and correspondence related to claims.
• Resolve credit balances through revenue adjustments and refunds.
• Document all collection efforts within the AR system accurately.
• Complete and submit monthly claim status reports.
• Inform management of reimbursement rates and issues affecting receivables.
• Maintain reimbursement records in compliance with company policies.
• Participate in departmental meetings and training sessions.
• Continuously improve processes and service quality for customers.
• Comply with safety and compliance policies and report any violations.
• Conduct special projects as requested by management.

Requirements

• High school diploma or equivalent required.
• Three years of healthcare-related experience, such as DME, home care, medical insurance, or medical case management.
• Basic knowledge of medical reimbursement principles.
• Excellent verbal and written communication skills.
• Ability to interact effectively with customers and all levels of management.
• Strong organizational skills and attention to detail.
• Intermediate to advanced Microsoft Office skills.
• Basic to intermediate understanding of Internet technologies, including payer portals.
• Ability to maintain confidentiality in accordance with HIPAA standards.

Nice-to-haves

• Pharmacy or home infusion experience preferred.

Benefits

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance