Reimbursement Specialist

About the Role

The Reimbursement Insurance Verification Specialist is responsible for obtaining and verifying a client's commercial insurance coverage, ensuring procedures are covered by an individual's insurance. This role involves entering and updating client benefit information accurately in the organization's billing system, performing auditing and resolution-centered activities, answering coverage questions, identifying insurance errors, and recommending solutions.

Responsibilities

• Analyzes designated eligibility reports on a daily basis.
• Communicates with and advises the Insurance Verification Team Leader of all questions or problems related to insurance verification.
• Adheres to all policies and procedures related to compliance with federal and state billing regulations.
• Communicates with billing representatives regarding any insurance issues that may arise.
• Maintains a positive and professional attitude.
• Reads and responds to all emails in a timely manner.
• Listens to and responds to all voicemails in a timely manner.
• Works with members of various teams and/or departments to identify process improvements.
• Possesses flexibility to work overtime as dictated by department/organization needs.
• Assists in determining proper courses of action for resolution to insurance issues.
• Researches and resolves discrepancies, denials, appeals, and collections using problem-solving skills.
• Demonstrates the ability to think outside the box and work in a high-stress/demanding environment.
• Performs additional duties as requested by Team Leads or Management Team.

Requirements

• Advanced use of computer systems, software, Excel, Outlook, and Microsoft Office (word processing and spreadsheet applications).
• Knowledge of Centricity is a strong plus.
• Knowledge of insurance guidelines including HMO/PPO, Commercial, Medicare, Medicare Advantage, TN Care's, Medicaid, and Private Pay.
• Ability to work well in a team environment and independently.
• Strong ability to triage priorities, delegate tasks if needed, handle conflict reasonably, and analyze and resolve claims issues.
• Strong written and verbal communication skills.
• Maintains patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
• Knowledge of the center's Policies and Procedures.
• Ability to maintain records and prepare reports and correspondence related to the position.
• Ability to work directly with upper leadership regarding claims issues and resolutions.
• Effective communication skills for phone contacts with insurance payers to resolve issues.

Qualifications

• High school diploma or equivalent required.
• Extensive knowledge of insurance in relation to proper billing, follow-up, and verification duties.

Job Expectations

• All employees must be clean and well-groomed; styles dictated by religion and ethnicity aren't restricted.
• Business casual dress code required.
• Employees can use their phones during breaks or at lunch hour.
• Must observe and be respectful of co-workers; never use obscene, discriminatory, offensive, prejudicial, or defamatory language.
• Use of cameras on cell phones during work time is prohibited to protect privacy unless permission is granted.
• Permitted two 15-minute breaks and one hour lunch.
• Must work the agreed-upon work schedule and enter hours worked daily.
• Request leave in advance from your supervisor for approval.

Schedule

Monday - Friday, 8:00 AM - 5:00 PM

Equipment/Technology

• Basic computer skills required for email, timekeeping, scanning, and fax machine.
• Advanced use of computer systems, software, Excel, Outlook, and Microsoft Office (word processing and spreadsheet applications).

Location

Knoxville, Tennessee