Reimbursement Account Liaison

Job Summary

About the Role

The Reimbursement Account Liaison manages financial activities related to patient payers, from product/service dispensation to payment completion. They act as a liaison between manufacturer accounts, billing departments, and healthcare clinicians, handling claims processing, including disputes, delays, and rejected claims.

Responsibilities

• Report reimbursement trends and issues to managed care organizations and inform business services divisions of renewal or new contract implementations.
• Maintain relationships with payer parties like insurance companies and government agencies to address slow payment and reimbursement issues.
• Communicate with patients, doctors, manufacturer account sales, and office personnel to handle medical billing inquiries and coverage questions.
• Track denials in the database to monitor underpayment occurrences and regularly report to management on payer policies, rates, procedures, and changes affecting the company.
• Participate in meetings to update staff on progress or problems and consider coworkers' suggestions for improving service quality or processes.
• Identify and maintain professional relationships with potential customers and coordinate with account teams to ensure business success.
• Provide excellent customer service to ensure customer satisfaction and manage all front-end paperwork for customer accounts.
• Cook up and manage customer account documentation, document, track, and resolve all plan providers' billing and payment issues.
• Research and respond to verbal and written providers' claims inquiries.
• Collaborate with various business units to resolve claims issues and instruct providers' billing staff and services on claims submission policies and procedures to ensure prompt and accurate claims adjudication.
• Identify and address authorization issues and trends, direct and educate Provider Services and Relations on claims reprocessing notifications, and utilize knowledge of provider billing and claims processing.
• Analyze trends in claims processing issues and assist in identifying and quantifying issues while reviewing work processes.
• Identify providers experiencing or at risk of claims issues and proactively work to eliminate barriers for accurate and timely claims processing.
• Notify applicable departments of potential and documented eligibility issues and resolve them.
• Meet with providers to discuss claims payment policies and procedures and resolve claims issues.
• Handle provider additions, changes, and terminations as needed.
• Run claims reports regularly through provider information systems.
• Assist the supervisor with compiling and preparing data for the Daily Dedicated Dashboard reporting.
• Report on the current patient statuses in the Dedicated Pharmacy Dashboard meetings.

Requirements

• Bachelor’s degree or related experience required.
• At least 4 years of relevant experience and strong knowledge base in healthcare policy and reimbursement for all payer types including Commercial, Medicaid, and Medicare.
• Experience building relationships with customers and giving presentations, audio conferences, and face-to-face visits.
• Strong organizational skills and extremely detail-oriented.
• High level of professionalism and excellent written and verbal communication skills.
• Excellent computer skills - MAC or PC, with strong spreadsheet and database management.