Reimbursement Specialist (PST Time Zone)

Responsibilities

• Researching and monitoring specific billing issues, trends and potential risks
• Reviewing and ensuring claims are submitted accurately with all pre-claim requirements
• Ability to track the status of claims and pull reports to manage work (especially in Excel)
• Review denied/unpaid claims and take appropriate corrective action with minimal guidance (i.e., resubmission, appeal etc.)
• When requested, providing administrative support for department(s) including but not limited to performing data entry, updating various record keeping systems, upholding company policies and Client requirements, and participating in projects, duties, and other administrative tasks
• Navigating payor portals, website or phone systems to check Eligibility, Prior Auth, Claim or Appeal statuses to obtain information needed to move claims \ forward in the life cycle
• Knowledge of payer guidelines and policies with ability to integrate it into daily decision making
• Assisting patients with navigating the financial journey with compassion and accuracy
• Verifying insurance/recipient benefits with Medicare, Medicaid and Private Insurer Payers
• Ensuring accurate and timely completion of billing responsibilities each day
• Reviewing and interpreting explanation of benefits

Qualifications

• Use of personal computer, computer applications, and general office equipment
• Experience with Microsoft Office (especially Word and Excel)
• 2+ years of experience in medical billing, insurance claims, or revenue cycle operations
• Familiarity with payer portals and claim tracking systems
• Familiarity with HIPAA compliance and healthcare privacy regulations
• Experience working with CRMs (i.e., Salesforce) and Billing Software (i.e., Epic, XiFin, Quadax)
• Strong, consistent work ethic with attention to detail and ability to focus on the big picture
• Ability to use analytical, interpersonal, communication, organizational, numerical, and time management skills
• Good organization skills with ability to meet deadlines and manage several projects at a time
• Enthusiasm and an entrepreneurial spirit
• Familiarity with ICD and HCPCS/CPT coding preferred
• Familiarity with CMS 1500 claim form preferred
• Familiarity with Claim Adjustment Reason Codes (NUCC) preferred