Accounts Receivable Reimbursement Specialist

Orthopaedic Specialty Group • Shelton, CT

1d

About The Position

JOB SUMMARY: Ability to identify reimbursement trends. Follows up on rejected claims and under payments using Practice Management software and Explanation of Benefit forms. Builds and maintains relationships with specified payors.

Requirements

• High school diploma required
• Minimum 1 year experience working in a physician group practice billing department
• Working knowledge of CPT and ICD10-CM coding for Orthopaedic surgery
• Comfortable using email and interacting with Internet applications
• Experience with EMR, PM system, and word processing software
• Able to establish good relationships with insurance companies
• Good analytical skills and an affinity for detail
• Ability to read and analyze accounts receivable and payor reports
• Pleasant speaking voice and demeanor
• Neat, professional appearance
• Strong written and verbal communication skills

Nice To Haves

• College education or trade school preferred
• Certified Professional Coding certification helpful

Responsibilities

• Account Follow Up
• Follows up on rejected claims the day that the rejected EOB is received
• Using data from the monthly aged accounts receivable report, calls payors or looks up claims status online to inquire about unpaid insurance claims that are 45 days old; records response or activity in the computer system "notes"
• Makes necessary arrangements for medical records requests, completion of additional paperwork, etc., if payors request this information prior to payment of claims
• Responds to written and telephone inquiries from insurance companies
• Manages relationships with personnel from assigned carriers
• Calls carriers to appeal payments that do not match contractual agreement; notifies Manager of payors for which this is a consistent problem
• Asks physicians or CPCs to provide appeal language for denials, or to support medical necessity
• Processes requests for refunds, and submits to Director of Revenue Cycle Management for approval
• Meets with Accounts Receivable Team regularly to discuss and solve reimbursement and insurance follow up problems
• Other
• Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the practice
• Attends regular staff meetings as requested
• Attends continuing education sessions as requested
• Performs any additional duties as required by the Billing Department

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED