Reimbursement Specialist

BetterHealth A Planned Parenthood Partnership

 Job Description

Job Title:                             Reimbursement Specialist

Location:                             Remote

Department:                      Revenue Cycle Management

Reports to:                         Associate Director of Affiliate Accounts

Employment Type:           Hourly, Non-Exempt

Travel Required:                Yes, less than 5%

Hourly Range:                     $23.00-$27.00

Summary

Candidate performs accurate submission of claims to various third-party commercial insurances, Medicare, and/or Medicaid. Responsible for the preparation of claims, payment posting for both self-pay and insured patients, accounts receivable, eligibility inquiries, answering phones, and aiding both internal and external customers. Knowledge of explanation of benefits, electronic remittance advice, and insurance terminology required. ICD-10 coding experience preferred but not required. Applicant must have excellent interpersonal and communication skills.

Essential Functions

• Comply with all agency protocols, policies, and procedures, including any state and federal laws and regulations.
• Maintain a positive attitude and excellent customer service skills.
• Secure sufficient coverage information to confirm with the insurer dates of eligibility and outline of benefits, and assist with patient requests relative to claim status, balance inquiries, and benefits administration.
• Prepares all government billing forms and invoices, including Medicaid, Medicare, and any other third-party government funding for medical services. Manages all files and submissions in a timely fashion. Ensure rebilling, as necessary.
• Conduct pre-submission review to ensure accuracy and completeness of claim coding, pricing, and coverage verification. Assist with code and error resolution.
• Conducts post-receipt review of explanation of benefits to ensure claims process correctly and patient benefits are administered accurately.
• Assist with code and error resolution. Perform all necessary follow-ups. Appeals claims as necessary to ensure resolution in a timely manner.
• Completes work queues in-basket messaging or tasking through the EMR system in a timely manner.
• Maintains quality percentage of 80% or higher with a goal of 95% benchmark for accurate billing.
• Accurately works credit reports and issues refunds and/or applies credits according to federal laws and regulations.
• Completes assigned reports from RCM Manager as assigned and reports to RCM Manager with any issues or discrepancies.
• Monitors and research claim rejections and denials and reports issues to RCM Manager.
• Knowledge of assigned payers’ policies, procedures, and ability to investigate those policies as required ensuring accurate claims submission and reimbursement.
• Provide support and assist in training as needed for IVT Specialists.
• Assist with insurance verifications as needed.
• Identifies inaccurate coding practices and reports to VP of RCM, Associate Director of RCM, and/or RCM Manager.

Supervisory Responsibility: This position has no supervisory responsibility.

Competencies

To perform the job successfully, an individual should demonstrate the following competencies:

• Customer Service and Interpersonal Skills, Oral and Written Communications
• Ethics, Diversity, Initiative, Teamwork
• Computer and Technical Skills
• Proficiency in mathematical concepts such as probability and statistical inference.
• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Quality, Safety & Security

Education and/or Experience

• High school diploma or G.E.D.
• Minimum 3 years of medical billing and customer service experience.
• Position requires an advanced knowledge of public and private insurance billing.
• Excellent computer skills and accuracy.
• Operate a 10-key calculator efficiently.
• Knowledge of Microsoft Office programs, including but not limited to Outlook, Excel, and Word documents. 
• Ability to navigate payer websites as assigned.

Skills

Required

• Strong spoken and written communication skills.
• Ability to read and interpret documents such as the schedule of benefits, training manuals, policies, and procedures.
• Ability to write routine reports and correspondence.
• Ability to speak effectively before groups of customers or employees of the organization.
• Ability to work with mathematical concepts such as probability and statistical inference.
• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Strong knowledge of Medicare, Medicaid, and Private/Commercial insurance.
• Ability to multitask

Preferred

• Experience with Epic EMR system
• Prior experience with medical insurance billing, claims concepts, denial and appeal follow-up and accounts receivable
• Remote work environment

Physical and Environmental Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit, talk, and listen. Specific vision abilities required by this job include close vision, distance vision, color vision, and ability to adjust focus.

Sedentary Work

• Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time)
• And/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects.
• Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.
• Must be able to travel throughout and between facilities.
• Normal routine involves no exposure to blood, body fluid or tissue and as part of their employment, incumbents are not called upon to perform or assist in emergency care or first aid.
• There is no occupational risk for exposure to communicable diseases.

Duties and responsibilities may be added, deleted, or changed at any time at management's discretion, formally or informally, either verbally or in writing.