Reimbursement Specialist

Responsibilities

• Facilitate payment from third party payers by performing duties such as correct billing, statusing, and collection.
• Post third party payments (if applicable).
• Compute correct reimbursement.
• Process incoming and outgoing correspondence.
• Maintain a working knowledge of current contracts and government regulations for multiple entities.

Requirements

• High school diploma or GED required.
• Associate's degree in business or finance; or equivalent experience in Medical Billing, Receivables or Collection preferred.
• Successfully pass EUPA's for all Epic applications associated with position within the first 90 days in the position.
• Strong computer and general office equipment knowledge required.
• Knowledge of medical terminology, ICD-10 and CPT-4 coding, National Billing forms, third-party payers, managed care, reimbursement and regulatory compliance preferred.
• Ability to type 45 words per minute is necessary.
• Effective communicator with patients, customers and co-workers.
• Quickly analyze communication style based on nature and approach of verbal inquiry.

Qualifications

• Accountable for ensuring claims are compliant with all payer specifications; State, Federal and HIPAA regulations.
• Resolves billing issues up front to promote better reimbursement, reduce outstanding revenue and time spent on working rejections or additional claim follow up.
• Prepares documentation to maximize reimbursement.
• Analyzes assignment of all CPT-4, ICD-10, UB04, HCFA 1500 and charges for accuracy and to maximize reimbursement from third party payers.
• Critically analyzes and processes third party and internal information requests and rejections in an effort to resolve accounts receivable.
• Processes documents for resolution of third-party liabilities, outstanding credits and un-billed accounts.
• Makes all necessary posting, adjustments and refunds to accounts and critiques contractual allowances and other arrangements.
• Responsible for complete understanding and application of current contracts and governmental regulations including referrals for legal intervention for multiple entities.
• Proficient in the revenue cycle process via multiple computer systems including but not limited to: Internal systems: EPIC, OnBase, SSI, system and External systems such as payer claims and eligibility systems.
• Verifies insurance eligibility using automated on-line systems.