Reimbursement Specialist

Role Summary

Performs a variety of AR activities and related tasks to recognize maximum reimbursement from each claim. Navigates EMR and billing systems to obtain/produce and transmit required records to insurance carriers or third parties. Understands EOBs and responds appropriately to denials and correspondence.

Responsibilities

• Analyze EOBs and construct responses to insurance carriers based on claim adjudication.
• Follow up with payers and other appropriate parties to collect open balances in a timely manner and ensure compliance with payer guidelines.
• Identify and report payer issues regarding rejection trends, denial trends, or changes in payments. Communicate specific payer information to appropriate parties/departments.
• Address denials and zero payments to identify and provide any requested documentation required to process the claim or refer to billing for claim corrections.
• Follow up and complete tasks on pending accounts in a timely manner until account is settled.
• Use of office equipment and software applications to facilitate finalization of claim.

Qualifications

• High school diploma or GED equivalent required.
• 2+ years of medical collections experience required.
• Intermediate level of expertise using Microsoft Office Suite (Outlook, Excel, Word, Teams) and PDF software (NitroPro).
• Familiarity with insurance payer rules and regulations.
• Strong comprehensive and analytical skills.
• Effective verbal and written communication skills including professional phone skills.
• Detail-oriented.
• Able to function as a cooperative team member with a positive attitude.
• Must have ability to work independently with minimal supervision and maintain confidentiality.
• Previous experience working with multi-state practices.
• Previous out of network experience.