Insurance Reimbursement Specialist

Job Summary

The Insurance Reimbursement Specialist will be responsible for document retrieval, analysis, claim processing, and reimbursement.

Essential Functions

• Have a full understanding of a medical claim cycle
• Possess the necessary knowledge to identify claim issues and apply resolutions to them
• Have a full understanding of the remit advice. Understand CAS codes and remark codes
• Able to submit corrected claims, appeals, reconsiderations, medical necessity letters, etc.
• Ideal knowledge of ICD diagnosis coding, modifier application and verification of CPT and/or HCPCS codes
• Responsible for ensuring all claims processed through EMR are correct and compliant
• Responsible for performing AR follow up
• Keeps abreast of and complies with coding guidelines and reimbursement reporting requirements
• Daily review and follow up on all incomplete electronic provider-billing encounters
• Ability to identify issues, correct code and/or pend due to missing information
• Apply in depth knowledge of coding principles to validate missing or incomplete CPT, HCPCS, or ICD-10 codes
• Appropriate assignment of diagnosis codes to CPT codes
• Review and completion of claim edits
• Review of Denials including writing appeals and facilitating their submission
• Vast knowledge of medical insurance rules and proper filing guidelines
• Ability to maximize reimbursement for claims
• Ability to run standard reconciliation reports
• Answer patient calls/questions, clinic staff calls, and insurance company calls
• Ensure resubmission of claims, when applicable, are accurate
• Ensure reimbursement of claims by submitting the most appropriate coding for services performed
• Maintain a professional relationship with insurance companies and patients

Qualifications Required

• A minimum of 3 - 5 years of medical ICD & CPT coding experience, Family Practice or Clinic setting is preferred
• Electronic Medical Record experience, eCW software highly preferred
• Excellent communication skills
• Problem solving skills
• Computer literate with entry level working knowledge of Microsoft Suites; Outlook, Word, Excel
• Demonstrated ability to organize, coordinate, prioritize, and facilitate many on-going tasks at one time
• Duties require professional verbal and written communication skills
• Ability to work independently or with a team
• Professional appearance
• Positive attitude

Minimum Required Education/Training

• A High School graduate or equivalent required
• Preferred but not required: AHIMA or CPC