Reimbursement Specialist

Full Time position in Baltimore, MD

About the role

Compiles data and prepares invoices and statements, following up on accounts for timely payment. Ensures strict adherence to company policy and procedure manual, including state and federal laws, and compliance with insurance companies' billing policies and procedures. Works closely with management to collect and lower accounts receivable (AR).

Responsibilities

• Ensure all assigned procedures—including insurance, denials, re-submittals, inquiries, re-certifications, orders, and other paperwork—are processed accurately and timely to ensure claims get paid.
• Communicate with insurance companies, patients, and other third-party payers regarding reimbursement, coverage, co-payment, deductible, and any pertinent information for account receivable reconciliation.
• Establish payment plans to help patients manage payment of bills.
• Report on AR, AR Alpha, Denial, and Payment vs Billed metrics.
• Create and mail insurance claims and patient statements.
• Submit claims to insurance companies or other third parties to secure payment for patients' claims.
• Make recommendations to management for write-offs.
• Respond to patient billing and statement inquiries.
• Perform other duties as assigned.
• Participate in Performance Improvement activities and training programs (traditional and e-learning).
• Work effectively with other employees, managers, and departments.
• Perform all job functions with company Mission, Vision, and Goal Statements in mind.

Requirements

• High school diploma or general education degree (GED); six months of related experience and/or training; or equivalent combination of education and experience.
• Proficient ability and practical knowledge of computers, software, and products applicable to the industry.
• Ability to quickly acquire knowledge of departmental program structure (Mission, Vision, and Goal Statements) and department policies and procedures.
• Ability to work a flexible schedule as needed.
• Effective time management skills while working independently with minimal supervision.

Skills

• Math Ability: Apply mathematical concepts such as basic algebra and geometry to tasks like calculating figures, discounts, interest, commissions, proportions, percentages, area, circumference, and volume.
• Language and Communication: Read, analyze, and interpret business periodicals, professional journals, technical procedures, and governmental regulations. Write reports, business correspondence, and procedure manuals. Present and debate information relevant to the role.
• Reasoning Ability: Understand, apply, and interpret extensive information, variables, and instructions where limited standardization exists. Define problems, collect data, establish facts, and draw valid conclusions.
• Technology Skills: Proficient use of personal computers, word processing, spreadsheet, accounting, inventory, internet, database, relational databases, statistical packages, project management software, and contact management systems. Ability to quickly learn company-specific software and handheld tools.
• Physical Demands: Work in a standard office setting using office equipment. Requires stamina to maintain attention to detail despite interruptions; strength to lift and carry files up to 10 pounds; vision to read printed materials and computer screens; hearing and speech for communication; manual dexterity for job functions; and stamina to sit for extended periods. Occasionally required to walk and lift/move up to 50 pounds.
• Proficient ability to foster professional working relationships using strong interpersonal and communication skills organization-wide.
• Productivity in a fast-paced environment with unscheduled interruptions while maintaining acceptable judgment and responsibility for decisions.

This job has no supervisory responsibilities. The job description involves no potential risk of occupational exposure to hazardous chemicals, blood, or other potentially infectious materials, though personal protective equipment (PPE) may be required for some duties with proper training and certification.