Medical Reimbursement Specialist

MC-Rx Powered by ProCare Rx • Miramar, FL

6d • Onsite

About The Position

The Medical Reimbursement Specialist will be responsible for submitting medical claims, ensuring accurate resubmission, and verifying the correct coding for services performed to ensure reimbursement. This role involves daily review and follow-up on electronic provider-billing encounters, identifying and correcting issues, and staying up-to-date on medical insurance rules and filing guidelines. The specialist will also handle patient and insurance company calls, maintaining professional relationships with all parties involved. Other duties as assigned.

Requirements

• Minimum 1 year of experience of medical ICD & CPT coding experience preferred.
• Electronic Medical Record experience, Emdeon (Change Healthcare) software highly preferred.
• Proficient with Microsoft Office Suite.
• Excellent verbal and written communication skills.
• Excellent organizational and time management skills.
• Analytical, problem solving, and critical thinking skills.
• Ability to organize, coordinate, prioritize, and facilitate on-going tasks.
• Ability to work independently and with a team.

Nice To Haves

• Certified Pharmacy Tech a plus
• Medical Billing/Coder Certification from accredited entity a plus.

Responsibilities

• Submit medical claims to appropriate payer.
• Ensure resubmission of claims, when applicable, are accurate.
• Ensure reimbursement of claims by submitted the most appropriate coding for services performed.
• ICD diagnosis coding, modifier application and verification of CPT and/or HCPCS codes.
• Responsible for ensuring all claims processed through Emdeon (Change Healthcare) are correct and compliant.
• Responsible for performing payer enrollment follow up.
• Keeps abreast of and comply with coding guidelines and reimbursement reporting requirements.
• Daily review and follow up on all incomplete electronic provider-billing encounters.
• Identify issues, correct code and/or pend due to missing information.
• Keep up to date on medical insurance rules and proper filing guideline.
• Answer patient calls/questions, clinic staff calls, and insurance company calls.
• Maintain a professional relationship with insurance companies and patients.
• Other duties as assigned.

Benefits

• Comprehensive Health Benefits: Medical, Dental, Vision, Short-Term/Long-Term Disability Insurance, Life insurance.
• Time to Recharge: Paid vacation and holiday pay.
• Focus on Your Wellness: We offer a robust Employee Wellness Program.
• Invest in Your Future: 401(k) with a company match.
• Support System: Employee Assistance Program provides confidential support and counseling.
• Get Rewarded for Referring Great People: Employee referral program.

What This Job Offers

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