Job Detail

PRIMARY FUNCTION: Reimbursement Specialist is responsible for analyzing the billing process to determine the appropriateness of payment (reimbursement). This position manages all components of claims processing, including: 1) coordination of disputed, rejected, and delayed claims, and 2) to problem-solve and review returned, disputed or rejected claims from the Government and other third-party payers. Additionally, this position is responsible for communicating with billers regarding coding processes to prevent future denials.

ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.)

• Non patient-facing

PERFORMANCE REQUIREMENTS:

Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI in accordance with organizational policy, Federal, State, and local regulations.

TYPICAL WORKING CONDITIONS:

Indoor Work

Operating Computer

Reach Outward

Manual Dexterity

Lift/Carry 20 lbs. or less

Push/Pull 12 lbs. or less

Sitting

Other Physical Requirements

Vision

Sense of Sound

Sense of Touch

EDUCATION: High school diploma/GED or equivalent.

LICENSURE/CERTIFICATION: None

EXPERIENCE: Minimum of 1 year of insurance/collection experience in a medical environment preferred.

KNOWLEDGE, SKILLS & ABILITIES:

• Knowledge of billing and collection policies and procedures, all types of insurance (HMO, PPO, POS, Medicaid etc.)
• Skill in defining problems, diagnostics of common coding errors, and impact on claims processing, collection of data, interpreting billing information.
• Must possess strong interpersonal skills; must be able to communicate effectively with co-workers, the Business Office Manager and must be able to work effectively as a team member within the Business Office.
• Ability to multi-task in a face paced environment while meeting established production and quality goals/metrics.
• Strong organizational skills, with ability to effectively prioritize work and daily basis and follow up on open items in a timely manner.