Under the general supervision of the Reimbursement Supervisor/Manager, is responsible for various reimbursement functions, including but not limited to accurate and timely claim submission, claim status, collection activity, appeals, payment posting, and/or refunds, until accounts receivable issues are properly resolved. PRIMARY DUTIES AND RESPONSIBILITIES:
Qualifications: EXPERIENCE AND EDUCATIONAL REQUIREMENTS:
- Collects and reviews all patient insurance information needed to complete the billing, collections, appeal, and/or cash processes.
- Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payors. Researches and resolves any electronic claim denials.
- Effectively utilizes various means for collections, including but not limited to phone, fax, mail, and online methods.
- Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
- Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers.
- Independently analyzes, reports, and communicates any reimbursement trends/delays (e.g. billing denials, claim denials, pricing errors, payments, etc.).
- Processes any necessary insurance/patient correspondence.
- Provides all necessary documentation required to expedite payments. This includes demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians.
- Coordinates with inter-departmental associates to obtain appropriate medical records as they relate to the reimbursement process.
- Provides training and support to inter-departmental associates.
- Independently and effectively resolves advanced accounts with minimal supervision.
- May travel to sites to present program services and further build relationship with sites.
- Maintains confidentiality in regards to patient account status and the financial affairs of clinic/corporation.
- Communicates effectively to payors and/or claims clearinghouse to ensure accurate and timely electronically filed claims.
- May have responsibility for particular geographic regions, physician office sites.
- Works on problems of diverse scope where analysis of data requires evaluation of identifiable factors. Demonstrates good judgment in selecting methods and techniques for obtaining solutions. Networks with internal and external personnel in own area of expertise.
- Typically determines methods and procedures on new assignments.
- Performs related duties and special projects as assigned.
Requires broad training in fields such as business administration, accounting, computer sciences, medical billing and coding, or similar vocations generally obtained through completion of a two year associate's degree program, technical vocational training, or equivalent combination of experience and education. Three (3) to five (5) years directly related and progressively responsible experience preferred. MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:
- Ability to communicate effectively both orally and in writing.
- Strong interpersonal skills.
- Strong negotiating skills.
- Strong mathematical skills.
- Strong analytical skills.
- Strong organizational skills; attention to detail.
- Proficient knowledge of accounting principles, pharmacy operations, and medical claims.
- Proficient knowledge of HCPCS, CPT, ICD-9 and ICD-10 coding.
- Global understanding of commercial and government payers.
- Ability to proficiently use Microsoft Excel, Outlook and Word.
- A seasoned, experienced professional with a full understanding of area of specialization; resolves a wide range of issues in creative ways. This job is fully qualified career-oriented position.
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