The Reimbursement Specialist serves as the subject matter expert in all Reimbursement responsibilities. This position performs all accounts receivable functions including qualification of appropriate documentation and billing. Helps ensures compliance with all government, contract, and company policies and regulations.
Essential Duties and Responsibilities include the following.
- Performs all duties of the Reimbursement Associate:
- Checks and understand eligibility and verification requirements
- Reviews claims using basic understanding of insurance coverage and criteria to help determine appropriate steps to submit payable claim
- Researches overdue accounts and follows up by mail and/or phone to insurance carriers or customers on delinquent payments
- Reviews denied or unpaid claims to determine proper resolution
- Resubmits general claims with proper documentation for further carrier review
- Responds to inquiries regarding account status in a timely manner
- Understands billing software in order to review customer information and enter data
- Maintains notes and documents progress appropriately and timely
- Brings recurring issues to the attention of management
- Files appeals and grievances on denied claims or authorizations/documentation.
- Identifies payer trends and issues and escalates when needed.
- Understands advanced Medicare/Medicaid qualifications to meet payer guidelines.
- Resolve discrepancies and prepare adjustments and refunds as necessary.
- Reviews medical records for audit purposes.
- Performs other duties as assigned.
Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education/Experience: High school diploma or GED equivalency required. Prefer 1 year home health, customer service, call center, insurance, or reimbursement experience. Strong interpersonal, communication, and organizational skills required.
Computer Skills: To perform this job successfully, an individual must have basic computer and typing skills.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The employee must occasionally lift and/or move up to 10 pounds. The employee is frequently required to sit; use hands to fingers, handle, and feel; and talk and hear. The employee is occasionally required to stand and walk.