Reimbursement Specialist

About the role

The Reimbursement Specialist is responsible for communicating and working with insurance companies and medical billing staff to manage billing and various reimbursements. This position requires an advanced understanding of records, coding, and billing practices to ensure compliance and patient confidentiality. If you have been in a previous insurance role and have strong organization skills, you may be the perfect candidate.

Responsibilities

• Performs routine inquiries to include eligibility and verification of benefits, obtaining financial information, maintaining accounts, and collecting charges for the support or treatment provided to clients.
• Submits timely, accurate invoices to payer for products and services provided.
• Understands the terms and fee schedule for all contracts for which invoices are submitted.
• Verifies that the services and products are correctly authorized and that required documentation is on file.
• Ensures that invoices are submitted for services and products that are properly ordered and confirmed as provided.
• Evaluates payments received for correctness and applies payments accurately to the EHR system.
• Verifies that payments received are correct according to the fee schedule.
• Applies payments correctly to client accounts.
• Notifies the Reimbursement Manager if there are overpayments and/or duplicate payments for the same service.
• Understands insurance carrier guidelines and coverage rules; stays abreast of changes and communicates them to management and staff.
• Investigates denied claims in a timely manner, including coordinating with clinical staff, to ensure that invoicing is accurate.
• Understands when claims should be corrected and refiled and when appeal packages must be submitted to collect the maximum revenue allowed.
• Monitors A/R reports and processes corrected claims, adjustments, or write-offs in EHR.
• Prepares monthly reports for the management team on the status of client/payer accounts worked.
• Ensures compliance with policies and guidelines outlined in the contract terms and fee schedule.
• Follows HIPAA guidelines when accessing and sharing patient information to maintain patient and business confidentiality.
• Other duties as assigned by the Revenue Cycle Management team.

Requirements

• High School Diploma or GED, plus two years of accounting, data entry, or general office experience required.
• Must have a valid Texas driver’s license and acceptable driving record, as well as personal automobile liability insurance as required by the State of Texas.
• Must have computer skills such as Word, Excel, and Outlook.

Skills

• Ability to work in a team environment, effective communication skills, and a commitment to customer satisfaction.
• Professionalism, accuracy, dependability, and confidentiality are essential.
• Ability to examine documents for accuracy and completeness and prepare claims and other records according to detailed instructions.
• Must be able to work independently and prioritize multiple tasks.

Schedule

8:00 AM – 5:00 PM (Monday – Friday), with flexibility.

Pay

$18 – $20 per hour (depending on experience and qualifications).

Benefits

• Employer-cost sharing of health insurance.
• Employer-paid short-term disability insurance.
• Loan forgiveness program.
• Employee Assistance Program.
• Pet insurance.
• Employer-paid term life insurance.
• Employer-match retirement contributions (up to 5% of base salary).
• Optional dental, vision, life, and long-term disability insurance.
• Wellness program.
• 12 paid holidays per year.
• 2 weeks of paid vacation leave per year with graduating accrual rate.
• 2+ weeks of paid sick leave per year.