Reimbursement Specialist I - Denials

$33,280 - $47,840/Yr

Hays Medical Center - Hays, KS

Full-time

Hays, KS

Hospitals

About the position

The Reimbursement Specialist I - Denials position at HaysMed involves performing various clerical duties related to eligibility verification, claim generation, submission, and resolution of insurance denials. The role is essential in ensuring accurate billing and follow-up on claims, contributing to the overall efficiency of the patient accounts department.

Responsibilities

• Review unbilled accounts and move to AR to bill at appropriate time.
• Generate claims through Meditech.
• Complete requests of itemized statements and understand rules of release of information.
• Resolve account checks in assigned worklist to release claim.
• Monitor and correct combined accounts within assigned worklist.
• Correctly update insurance information in the EHR (Electronic Health Record).
• Update coding information as directed by the HaysMed coding team.
• Review and correct pending claims or bills; prepare claims for electronic or paper submission.
• Understand ANSI errors generated in the claims clearinghouse and resolve them prior to claim submission.
• Research payers' claim acceptance trends and notify supervisor of discrepancies or updates.
• Print required information when claim in the clearinghouse indicates that the payer only accepts paper claims.
• Identify specialty claims and understand processes for those payers.
• Submit additional documentation requests when appropriate.
• Collaborate with the denials team to ensure that claims are releasing accurately.
• Enter payor payments, adjustments, diagnosis, and accident information to appropriate accounts.
• Review daily reports of aging account receivables and collection worklists; contact insurance companies on outstanding accounts; document conversation and correspondence.
• Update demographic and insurance information in the EHR.
• Research denial, unpaid claims, and aging reports at assigned intervals.
• Maintain RTP system for claim updates and notify payer.
• Utilize payor portals for eligibility checks.
• Update company demographic information as given.
• Understand split billing rules and submit claims using those specific rules.
• Using coding guidance, move codes to appropriate account.
• Utilize the EMR to determine when other services were provided to determine appropriate billing.
• Review clinical information for all appeals using nationally recognized criteria to determine the necessity of services requested.
• Prepare reviews for cases that do not meet required criteria.
• Coordinate and deliver verbal and written information regarding patient and provider appeals, ensuring all letters meet required standards.
• Maintain files and logs related to all appeals.
• Coordinate hearings with various internal departments and agencies.

Requirements

• High school diploma or equivalent is required.
• Satisfactory performance and one year experience preferred.
• One year of working in a healthcare office setting preferred.
• Previous insurance or bookkeeping experience preferred.
• Certified Professional Biller preferred.

Nice-to-haves

• Infection Control: Initial and ongoing training in dealing with infection control, including blood borne pathogens, bodily fluids, and biohazardous materials as it applies to daily work environment.
• Periodic patient interaction.