Reimbursement Specialist [United States]

 

Job Title: Reimbursement Specialist

Location: Remote

Department: Revenue Cycle Management

Reports To: Associate Director, Revenue Cycle

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Employment Type: Full-time, Non-Exempt

Travel Required: No

Salary Range: $22.00 - $24.00/hour

Summary

The Reimbursement Specialist supports one or multiple affiliates’ Revenue Cycle activities by performing all billing and collection functions for selected payer groups/financial classes, including posting and follow up on all outstanding Accounts Receivables (A/R). Provide feedback as appropriate to improve affiliate performance and increase reimbursement. Complete billing special projects as assigned.

Essential Duties and Responsibilities

• Conduct appropriate claim follow-up on all open A/R to ensure prompt adjudication, maximize revenue and maintain the affiliate key Performance Indicators.
• Perform daily ERA, EOB, Rx and patient payment posting.
• Review and monitor clearinghouse claim errors and global payer rejections for possible system edits or payer updates.
• Analyze payer denial trends, strategize, and test various billing methodologies and payer coding requirements to ensure payment of all claims due to the affiliate.
• Ensure month-end activities are completed in a timely manner and that month-end reconciliation is accurately completed prior to contractual deadlines.
• Run all reports needed to successfully manage the claims business for specified payers/financial classes.
• Ensure the affiliate’s claim KPIs are satisfied within specified payer group(s).
• Participate in Revenue Cycle Team meetings/conference calls, and provide the necessary reporting, feedback, and training required to improve processes.
• Serve as an active agent on the BetterHealth billing line.
• Attend BetterHealth, PPFA, affiliate-specific, and other assigned training to improve knowledge base and claim efficiency.
• Complete special projects as needed.
• Oversee and improve billing and collection strategies and systems in assigned payer category.
• Submit daily electronic and paper claim files, and correct all NextGen claim edit rejections; run statement files; and download ERAs/EOBs as needed.

Supervisory Responsibilities

This role has no supervisory responsibilities.

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.

• Three to five years’ experience in medical billing and/or Accounts Receivable
• Experience with patient billing and collections
• Ability to handle confidential materials that relate to a variety of individuals.
• Ability to thrive in a fast-paced environment.
• Superb attention to detail
• Strong problem solving skills.
• Ability to work independently, including handling multiple projects/tasks simultaneously.
• Access to secure, reliable Internet and utilities; access to send outgoing mail.

Education and Certifications

• Bachelor’s degree preferred, high school diploma or equivalent required

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