Reimbursement Specialist

Overview   A Reimbursement Specialist is a medical professional responsible for managing the administrative responsibilities of billing insurance and processing payments for clients.

A Reimbursement Specialist is also responsible for Accounts Receivables, making any corrections to resubmission of any claims.

In addition, they communicate with patients about outstanding balances, collecting on behalf of their employer or provider institution as necessary to ensure the patient’s procedures are paid for by their insurance company.  In addition, Reimbursement Specialist is to be experienced with billing software and medical insurance policies Responsibilities Provide excellent customer service to patients, office staff, and providers To confirm patient benefits and insurance eligibility.

To follow and adhere to all regulations and guidelines set by state programs, and  HMO / PPO, etc.

Review charges prior to submission Review clearinghouse rejection reports and correct any errors and resubmit Ability to interpret diagnostic and procedural phrases used by healthcare providers  into coded form by locating such codes utilizing the coding manuals or software.

In-depth knowledge of CPT, ICD-10, and HCPCS coding.

To transfer insurance claims and billing data to billing software.

To update billing software with rate changes.

To create both paper and electronic Claims for transmission.

To follow up on late payments and initiate late payment notices to relevant parties.

To monitor and resolve financial discrepancies.

Runs reports weekly on accounts and monitors to keep the contents at a minimum.

• Verifies all claims and ensures edits are collected and released in a timely fashion
• Ensure that all charges are entered in a timely fashion.

Run reports on denials and correct to resubmit claims.

Examining patient bills for accuracy and requesting any missing information.

Contact patients with unpaid medical bills and negotiate payment plans or settlements.

Respond to inquiries regarding billing and account related matters.

Maintain strict confidentiality with regard to all client information.

Adheres to all HIPAA  guidelines / regulations.   Other duties as assigned.

Qualification and Skills :

Perks :

Job Types :