Medical Billing Reimbursement Specialist

Medical Billing Reimbursement Specialist

Requirements

• Ability to read and understand EOBs
• MS Excel skills (filtering and formatting reports)
• MS Word skills (formatting of letters and templates)
• PDF (formatting and editing in Adobe Acrobat or equivalent)
• Position requires HS or GED equivalent and some college level courses
• Ability to speak confidently to insurance representatives and patients
• Experience in billing 1500 and UB04 claim forms
• Understanding of non-contracted and contracted payer behaviors
• Ability to interact professionally on all levels
• Type 45 wpm, 10-key by touch
• Knowledge of medical terms
• Ability to operate office equipment
• Candidate must be able to provide documentation to support ability to work in the United States within the federal legal guidelines.

Responsibilities

• Denial Management – Research and determine claim denials and take appropriate action for payment within federal, state, and payor guidelines.
• Trend Identification – Identify consistent payor or system trends that result in underpayments, denials, errors, etc.
• Payor Escalation – Ability to understand and navigate payor guidelines. Determine and escalate claim issues with payor when appropriate.
• Trend Escalation – Meet with leadership to discuss/resolve reimbursement and/or payor obstacles.
• Appeals – Determine when an appeal, reopening, redetermination, etc. should be requested and the requirement of each insurance carrier. Take appropriate action to resolve claim.
• Claim Status – Use available resources such as payor portals and clearinghouses to review unresolved accounts.
• Unapplied Payments – Identify unapplied payments and take appropriate action to resolve account.
• Phone Calls – Call appropriate payors or patient to obtain the information necessary to resolve the claim.
• Medical Record Requests – Obtain necessary information from appropriate source(s) to obtain payment from payors. This includes obtaining records from treating facilities.
• Medical Insurance Policies – Knowledge and understanding of current policies and procedures required to determine claim resolution.
• Overpayment Resolution – Process or appeal refund requests following federal, state and/or payor guidelines.
• Legal/Subrogation Requests – Knowledge of HIPAA and multiple state guidelines to process attorney requests.
• Coordination of Benefits – Ability to review eligibility response and determine payor sequence. Knowledge of Medicare Part A vs Part B benefits and liability guidelines.
• Patient Inquiries – Respond to written and verbal inquiries from patients regarding their account. Process charity and payment plan following established policy.
• Communication – Clear and concise communication both written and verbal, including documenting all activities associated with an account.
• Production and Quality Standards – Must meet company standards and ability to work in fast paced environment.
• Other responsibilities as assigned.

Preferred Qualifications

• Prefer minimum 3 years in medical reimbursement field