Lead Reimbursement Specialist - Remote, must be based in PST

Position Summary

The Lead Reimbursement Specialist is responsible for all revenue cycle functions for assigned fee for service/third party facilities, including insurance verification, census, authorization management, billing, collections, cash posting, collections, denials, appeals and write-offs/refunds. Additionally, the Lead Reimbursement Specialist serves as the main help contact for the Reimbursement Specialists in their group. This includes providing support during contract/payer changes, training new staff, and reviewing work of new staff. The Lead Reimbursement Specialist keeps up to date on all applicable CPT and other coding changes, fee for service and/or contract billing rates, and communicates those changes to all affected parties at Telecare.

Required Qualifications

• Six (6) years of full cycle revenue cycle experience and extensive knowledge of Medicare, Medi-Cal/Medicaid and commercial insurances
• A high level of PC literacy, especially in Excel and Word
• Prior experience training staff, using exceptional communication skills
• Critical thinking and data validation skills are mandatory
• Ability to identify and escalate issues and conflicts to management timely
• Understanding of accounting principles and the ability to balance detailed accounts to the general ledger
• The ability to operate independently, handle multiple tasks simultaneously and complete assignments with minimal supervision
• Demonstrated capacity to work with sophisticated automated billing systems
• Must be at least 18 years of age

Essential Functions

• Assists in developing the overall philosophy and objectives of accounts receivable services in accordance with the corporate mission
• Serves as main point of contact for Single Case Agreements that need to be negotiated for the programs in assigned billing group
• Performs and/or knows all the billing and collection activities for assigned programs, ensuring timely and accurate billing including:
• Confirm census, financial eligibility, authorizations
• Complete paper and/or electronic billing to multiple payers
• Post payments, manually and electronically
• Identify under/overpayments and process refunds
• Respond to claim denials timely
• Run aging reports for collection call identification and complete collection calls and follow-up note entry
• Identify bad debt and complete write-off requests
• Identify/complete billing adjustments
• Complete client statements
• Complete month-end reconciliation
• Collaborate with Billing Manager in strategic planning or development activities with the goal of ensuring ongoing effective billing and reimbursement
• Active member of the Financial Review Committee, creating the agenda and leading the discussions about the pending receivables
• Keep Billing Manager informed of status of account receivable for the billing unit
• Mentor new staff in the billing group and perform majority of staff training
• Promote and maintain harmonious and effective relationships and communications within the department, with other departments, with government representatives and with customers
• Consistently update knowledge of regulations, procedures and standards to assure compliance with contractual obligations and directives from governmental and regulatory agencies, fiscal intermediaries and contracting entities
• Review month-end packets for Reimbursement Staff in billing group – correct errors with staff as necessary
• Provide technical support and oversight of third-party reimbursement functions performed at the program level, especially for new programs
• Work with the Billing Manager to implement and maintain written policies and procedures so that the appropriate submission, billing, and payment cycle of client accounts are maintained
• Actively participate in meeting customer needs and adapting to changing customer needs at all times
• Participate as a Revenue Cycle Department member and provide input via reporting observations, concerns, and asking appropriate questions
• Follows proper internal controls

Physical Demands

• The physical demands here are representative of those that must be met by an employee to successfully perform the essential functions of this job.
• The employee is constantly required to sit and occasionally required to stand, walk, reach, twist, bend, pull and lift and carry items weighing 10 pounds or less as well as to do simple grasping occasionally.
• The position requires manual deviation, repetition, and dexterity.
• Visual requirements include computers and books exposure.