Reimbursement Specialist

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Our benefits include: competitive compensation based on industry standards, an excellent benefits package, which includes: generous 401(k) match with immediate vesting, growth opportunities, health insurance benefit opportunities which include Medical, Dental, Vision, excellent PTO which increases based on tenure, holiday pay, and a fantastic company culture!

SUMMARY:

The Reimbursement Specialist is responsible for billing and securing payments from customers for goods and services provided by the company. This includes reviewing and/or securing prior authorizations and required documentation, order confirmation, handling inbound and outbound phone calls, working a variety of Accounts Receivable reports, reviewing denials and resubmitting claims as appropriate, and various clerical tasks in support of this work.

ESSENTIAL FUNCTIONS:

1. Timely and accurate order review and confirmation.
2. Secure payments from insurance companies, government offices, patients, and other customers as assigned via phone, email, online systems and USPS per guidelines.
3. Review claim denials. Resubmit invoices, file appeals or adjust accounts according to established policy and procedure.
4. Helps educate patients on their financial responsibility for billed items and any applicable rules and regulations.
5. Communicates professionally with physician offices and all other referrals to obtain medical documentation necessary to secure payment.
6. Audit claims and escalate identified issues to manager.
7. Work cooperatively with other department employees as needed to secure payments, including customer service, branches, sales and others as needed.
8. Maintain compliance with all applicable rules and regulations.
9. Support department projects and initiatives to achieve production goals.
10. Other duties as assigned by the Manager.

REQUIRED EDUCATION AND/OR EXPERIENCE:

1. High School diploma or GED equivalent.

PREFERRED EDUCATION AND/OR EXPERIENCE:

1. Six months’ accounts receivable experience in a healthcare/insurance/medical environment.

ADDITIONAL QUALIFICATIONS:

None.

COMPETENCIES:

• Adaptability
• Customer Service / Client Focus
• Detail oriented
• Problem solving
• Teamwork

POSITION TYPE/EXPECTED HOURS OF WORK:

This is a full-time position, and hours of work and days are Monday through Friday, 8:00 a.m. to 5:00 p.m. to start, with the possibility of flex scheduling based on department needs and individual performance.

SUPERVISORY RESPONSIBILITY:

This position has no supervisory responsibilities.

WORK ENVIRONMENT:

This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

PHYSICAL 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. This is primarily a sedentary position, spending most of the workday sitting at a desk in an office setting. The employee may occasionally be required to climb or balance; stoop, kneel, crouch or crawl. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include both close and distance vision, color and peripheral vision, depth perception and ability to adjust focus.

TRAVEL:

No travel is typically not expected for this position.

OTHER DUTIES:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

EEO

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