Clinical Reimbursement Coordinator

Oklahoma Arthritis Center•Edmond, OK

About The Position

Clinical Reimbursement Coordinator involves navigating complex coding, payer policies, and documentation requirements unique to clinical services, evaluation and management, and procedures. This dedicated clinical reimbursement coordinator will ensure swift denial resolution for clinical services, optimizing revenue capture and compliance. This role reduces the burden on infusion follow-up specialists by concentrating on clinical reimbursement workflows, keeping up with regulatory changes, and coordinating with clinical staff to clarify documentation and correct billing errors.

Requirements

Knowledge of medical billing and collection practices.
Knowledge of basic medical coding.
Knowledge of third-party payer operating procedures and practices.
Knowledge of Medicare requirements.
Proficient skills in computer programs.
Skill in trouble-shooting insurance claims and problems.
Skill in establishing and maintaining effective internal and external working relationships.
Ability to accurately enter data and examine insurance documents.
Ability to deal courteously with patients, staff and others.
Ability to communicate effectively and clearly.
A High School Diploma or GED required.
A combination of six to twelve months of directly related training and/or billing experience in a health care organization is typically required for carrying out the responsibilities for this job.
Ability to work effectively in a fast-paced environment.
Physical ability to sit, perform data entry and view computer screen for long periods at a time.
Occasional exposure to communicable diseases and biohazards.
Daily standing, walking, bending, and maneuvering.
May require lifting up to 50 pounds or more to transfer and/or turn patient with and without assistive devices.

Responsibilities

Recognize and track denial trends by payer.
Research how to resolve denial issues.
Serve as a liaison between OAC and Provider Reps and communicate issues causing denials/payment delays with payers.
Coordinate follow-up projects as needed.
Train team members.
Provide weekly updates to the Billing Manager and Director of Revenue Cycle regarding overall A/R issues.
Other duties as assigned by the Billing Manager.
Answers patient questions regarding their accounts and insurance coverage.
Contacts insurance companies to verify medical insurance coverage for patient and to obtain information concerning extent of benefits. Determine patient’s payment responsibility for procedures.
Research and correct all insurance denials.
Identify delinquent accounts, aging period and payment sources. Processes delinquent unpaid accounts by contracting patients and third-party payers.
Perform various collection actions including contacting patients by telephone and/or letter and resubmitting claims to third-party payers.
Evaluate patient financial status and establish payment plans. Follow and report status of delinquent accounts.
Review accounts for possible assignment to collection agency or other account determination.
Help patients with Patient Assistance programs.
Responds to patient/payer inquiries in a timely manner.
Follow up on unpaid or improperly paid claims as necessary.
Reviews and monitors select accounts within the accounts receivable.
Ensure patient confidentiality and follow HIPAA guidelines.
Promote a professional image by adhering to the established dress code as listed in Employee Handbook.
Check and resolve assigned tasks in EHR program
Other duties as assigned by Administration.
Assist co-workers as needed.
Recognize when others are in need of assistance, information or directions and offers to help when able, or find someone who can.
Responsible for neatness of work area to include stocking and cleaning. Be productive when faced with any “down time” during work hours.
Maintain emotional control and diplomacy at all times.
Maintain open and positive lines of communication.
Consistently report to work on time, begins work promptly and perform duties for entire scheduled shift.
Maintain absenteeism within company policy.
Notify Administration of absences and tardiness in a timely manner.
Read new policies and documents as instructed.
Adhere to company policies and procedures.
Demonstrate sensible and efficient use of equipment and supplies by limiting waste, spoilage or damage.