Reimbursement Specialist

Job Grade: 4

Purpose of job:

The Reimbursement Specialist is responsible for managing outstanding worker’s compensation claims by collecting payments, resolving billing issues, and minimizing the number of uncollectable accounts. The ideal candidate will be results-driven and able to focus on key performance metrics to ensure quality and efficiency standards set forth by the company are met.

Main Duties

• Contact insurance payers, employers, or responsible parties in an effort to collect on outstanding accounts receivables.
• Identify and resolve improper payments, incorrect denials, billing errors and payer discrepancies.
• Compile accurate and effective appeals and disputes to the appropriate payers and state divisions.
• Ensure individual and department goals are met, specifically:

          - Reduce the number of past due accounts through timely follow-up;

          - Reduce the number of past due accounts through escalation and claim resolution;

          - Increase cash performance through effective and persuasive collection attempts;

          - Reduce the number of days in AR for uncollectable accounts

• Research, compile, maintain and manage quality data related to collection efforts.
• Provide feedback to management regarding payer issues, underpayments and denial trends.

Qualifications:

• High school diploma or equivalent
• General Office Knowledge (Microsoft Excel and Word)
• Proper phone and email etiquette

Knowledge, Skills and Abilities:

• Ability to review, analyze and interpret payor reimbursements, billing guidelines, and state or federal regulations.
• Detail oriented, with strong analytical, organizational and problem solving skills.
• Communicate professionally and effectively with employers, insurance payers, and UHS customers.
• Demonstrates a strong work ethic by managing time effectively and completing all tasks as assigned.
• Ability to balance productivity with a high-quality level of work standards.
• Adaptable with the ability to learn and apply knowledge of new programs and procedures quickly.
• Maintain confidentiality and appropriate HIPAA compliance guidelines.