Reimbursement, Reimbursement Specialist (Medical Records Focus)

About the Role

This individual is responsible for resolving insurance claims for laboratory test services that require medical record documentation by requesting records from clinician offices, following up on those requests, and submitting complete medical records to payers based on their requirements, medical policy, or state laws, while providing the highest level of customer service to internal and external customers.

Responsibilities

• Spends most of the time communicating with ordering clinicians and their staff via phone, fax, and email to obtain the necessary patient medical records
• Analyzing received records to ensure all required documentation is included, and securing any missing information
• Preparing medical record cover letters and submitting documentation to demonstrate medical necessity or compliance with medical policy criteria
• When needed, creates custom submission letters with arguments that support claim processing according to payer policy, state laws, or Medicare regulations
• Contacts patients, physician offices, or sales to gather any remaining required information

Requirements

• High School Diploma or equivalent GED or equivalent work experience
• Two years of health insurance billing with experience in identifying and resolving claim issues for laboratory tests
• Must have a working knowledge of various payers' designations of authorized representative forms
• Experience handling a high volume of claims work on a daily basis (35 plus claims per day)
• Must demonstrate the ability to type 35 WPM with 90% or higher accuracy

Benefits

• Excellent Annual Salary + 20% Bonus Potential
• 20 Accrued PTO Days Annually + 10 Paid Holidays
• 401K with 100% Company Match up to 6%
• 3 Health Care Plan Options + Company HSA Contribution
• Company Stock Grant Upon Hire

Pay

Salary Range: $46,000.00 - $47,277.00. Final salary is based on Experience and Education levels.

Schedule

Monday - Friday, 8:00 AM to 5:00 PM, non-exempt position, working remotely from your home office based in the USA.