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Reimbursement Representative (Hybrid Plano, TX)
Reimbursement Representative (Hybrid Plano, TX)US Renal Care • Plano, TX, United States
Reimbursement Representative (Hybrid Plano, TX)

Reimbursement Representative (Hybrid Plano, TX)

US Renal Care • Plano, TX, United States
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USRC's greatest strength in being a leader in the dialysis industry is our ability to recognize and celebrate the differences in our diverse workforce. We strongly believe in recruiting top talent and creating a diverse and inclusive work climate and culture at all levels of our organization.

SUMMARY

The Reimbursement Representative performs reconciliation and review of all outstanding Medicare / Commercial patient balances in accordance with US Renal Care reimbursement policies and procedures. Candidates should reside in the Dallas / Fort Worth, TX area commutable to Plano, TX.

Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.

  • Reviews EOB / EOMB's for proper reimbursement.
  • Resolves electronic claim rejections and Explanation of Benefits denials in a timely manner.
  • Reviews and researches insurance correspondence and makes necessary corrections to ensure claims payment.
  • Follows up on unpaid / unresolved account balances, including claims rejected electronically, EOB denial and working A / R aging reports as directed. Provides insurance carriers with requested information to facilitate payment.
  • Regularly contacts Medicare, Medicaid and / or Commercial payors for resolution to claims not paid or claims not paid according to plan benefits.
  • Performs claim appeals as required.
  • Assists with credit balance resolution.
  • Completes re-bill request as necessary to facilitate timely and proper claims payment.
  • Follows up on unresolved account balances including RTP's.
  • Prepares adjustment and write-off requests as necessary.
  • Performs other duties and responsibilities as required or assigned.

Qualifications / Requirements :

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

Requirements include :

  • High School diploma or GED require
  • At least two years of experience in a health / medical billing and collection office.
  • Ability to use copier, fax machine, printer, calculator and multi-line telephone
  • Must be proficient with computers with an understanding of medical billing software
  • Advanced knowledge of medical terminology as well as knowledge of government and private insurer rules and regulations.
  • Advanced knowledge of CPT, ICD-9 and HCPCS coding as well as in-depth knowledge of medical billing requirements
  • Working knowledge of Microsoft Outlook, Word and Excel
  • Ability to utilize the internet, specifically Medicare and Medicaid websites
  • Maintain confidentiality in regard to HIPAA rules and regulations, as well as private company matters
  • All Full Time employees are eligible for the following benefits :

  • Medical / Pharmacy
  • Dental
  • Vision
  • Voluntary benefits
  • 401k with employer match
  • Virtual Care
  • Life Insurance
  • Voluntary Benefits
  • PTO
  • All Part Time employees are eligible for the following benefits :

  • 401k with employer match
  • PTO
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    Reimbursement Representative • Plano, TX, United States