Reimbursement Representative

Essential Duties and Responsibilities

• Reviews EOB/EOMB's for proper reimbursement.
• Resolves electronic claim rejections and Explanation of Benefits denials in a timely manner.
• Reviews and researches insurance correspondence and makes necessary corrections to ensure claims payment.
• Follows up on unpaid/unresolved account balances, including claims rejected electronically, EOB denial and working A/R aging reports as directed.
• Provides insurance carriers with requested information to facilitate payment.
• Regularly contacts Medicare, Medicaid and /or Commercial payors for resolution to claims not paid or claims not paid according to plan benefits.
• Performs claim appeals as required.
• Affords assistance with credit balance resolution.
• Completes re-bill request as necessary to facilitate timely and proper claims payment.
• Follows up on unresolved account balances including RTP's.
• Prepares adjustment and write-off requests as necessary.

Qualifications/Requirements

• High School diploma or GED required.
• At least two years of experience in a health/medical billing and collection office.
• Ability to use copier, fax machine, printer, calculator and multi-line telephone.
• Proficient with computers with an understanding of medical billing software.
• Advanced knowledge of medical terminology as well as knowledge of government and private insurer rules and regulations.
• Advanced knowledge of CPT, ICD-9 and HCPCS coding as well as in-depth knowledge of medical billing requirements.
• Working knowledge of Microsoft Outlook, Word and Excel.
• Ability to utilize the internet, specifically Medicare and Medicaid websites.
• Maintain confidentiality in regard to HIPAA rules and regulations, as well as private company matters.