Reimbursement Specialist

Ideal Candidate

• Healthcare industry experience
• Proficiency in billing systems
• Strong attention to detail

Essential Functions

• Aids in coordinating and maintaining the reimbursement program
• Maintains compliance with current payments, rules, and legislative regulations
• Evaluates current reimbursement/payment rules and policy guidelines
• Maintains HIPAA, JCAHO, and Compliance rules and regulations
• Reviews authorization, detailed prescriptions, and verification for claims
• Works towards minimizing AR within assigned workgroup
• Communicates with various insurance companies and payers to resolve billing and reimbursement discrepancies
• Reviews information provided by payers regarding the reimbursement for goods and services
• Trends identification should be performed through this process and escalated to management for global resolution
• Confirms and prioritizes pick-ups, exchanges, and returns on both serialized and non-serialized equipment and supplies
• Ensures that claims are followed up in a timely manner
• Prepares and submits medical records to the various payers on request
• Meets or exceeds Key Performance Indicators (KPIs) and productivity in all measured areas
• Performs other duties, as assigned by management

Qualifications and Requirements

• High School Diploma or equivalent
• Background in healthcare related industry experience required
• Competent level of experience in medical billing (2-3 years minimum)
• Experience in Brightree and/or DME preferred
• Knowledgeable of insurance requirements, policy guidelines, and ability to determine medical justification by reviewing documentation
• Ability to type over 30 WPM and navigate computer programs accurately and efficiently
• Ability to effectively operate billing software and patient portal

Competencies

• Attention to Detail
• Integrity
• Cohoperation
• Effective Communication
• Proficiency in Microsoft Office Suite

Physical Requirements

• Prolong periods sitting at a desk and working on a computer
• Must be able to lift up to 15 pounds at times