Grapevine, Texas
Medical Reimbursement Specialist Job Opening in Grapevine, Texas - Job Description
Reimbursement Specialist
General Summary
Reimbursement Specialist is responsible for following-up on outstanding Accounts Receivable in either Commercial, Workers Compensation or Government Insurance.
Job Requirements
ESSENTIAL JOB FUNCTIONS
Contacting insurance companies to resolve aged accounts.
Writing and filing appeals with insurance carriers.
Working all short paid encounters or outstanding balances.
Dependability is essential: You must be able to work consistently and on time while following instructions, responding to management direction, and soliciting feedback to improve performance.
Verifies status of pending claims and approximate dates of upcoming payments.
Review ERAs/EOBs and initiate appeals as necessary.
Verifies payments and discounts with insurance carriers.
Work all payer denials.
Adheres to HIPAA guidelines and Federal Privacy Law.
Provides feedback to management regarding possible problems and areas of improvement.
Responsible for answering a variety of customer phone calls, identifying patient grievances and escalating properly while providing excellent customer service and handling all inquiries in a timely and professional manner.
Responsible for all daily productivity reporting requirements.
Maintains and exceeds department standards for productivity and quality.
Ensures compliance with state and federal laws and regulations for Commercial, Medicare, Medicaid, Managed Care, and other payers.
Continually seeks to understand and act upon employer and customer needs, concerns, and priorities. Meets employer expectations and requirements, and gains customer trust and respect.
Functions effectively within a team and participates and contributes constructively to produce results in a cooperative effort.
Demonstrates ongoing enthusiasm and commitment to the work assigned.
Works with others to receive feedback and create a personal development plan.
Participates in a process to continually improve organizational effectiveness using self-assessment performance evaluation criteria.
The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform job related tasks other than those specifically presented in this description.
SPECIFICATIONS
Knowledge and Abilities
High School Diploma or equivalent certification.
Prior Therapy claims knowledge is preferred.
Ability to work independently with minimal supervision as well as ability to work in a team environment.
Must be able to balance the ability to collect on outstanding balances while maintaining a high level of customer service.
Must be able to handle a high volume of inbound and outbound calls and properly document each conversation with the encounter notes field.
Skilled at managing multiple projects and grasping new concepts.
Knowledge of healthcare industry with emphasis on Revenue Cycle processes.
Medicare, Medicaid, Commercial, and Workman?s Comp Insurance Knowledge.
Computer skills and experience with Microsoft Applications.
Accurately complete assignments while meeting deadlines.
Excellent organization skills.
Excellent internal and external customer service skills.
Must possess good oral and written communication skills and recognize importance of teamwork.
Proficiency in Microsoft Office with Excel skills.
Working knowledge of the Raintree System.
Knowledge of CPT, ICD-9/ICD-10 codes.
Complete knowledge of ERA?s/EOB?s.
Knowledge of medical terminology.
Experience
Two to four years Revenue Cycle experience in healthcare environment, preferably within comparable Physical Rehab organization.
Two to four years Prior Medical Receivable collections experience preferred.
Understanding of Medical Claims Processing preferred.
Experience with insurance systems, Medicare and Medicaid online systems preferred.
Experience with the Raintree system preferred.
Within the bounds of their respective job descriptions, all staff is expected to exercise principle-centered leadership, focused on customer service responsiveness, with a continuous quality improvement orientation.
Job Type: Full-time
Required experience:
Reimbursement: 2 years
Medical Billing: 2 years
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