Employer Direct Healthcare-posted 3 months ago
Dallas, TX
11-50 employees
Ambulatory Health Care Services

Our Reimbursement Specialists are a central points of contact for our provider network. The primary responsibility of the role is to deliver effective, accurate payment and communication to our providers. The day-to-day responsibilities of our Reimbursement Specialists include payment processing, researching, accurate billing/payment disbursement, and ensuring payment data accuracy and integrity. The desired candidate is articulate, empathetic, pragmatic, self-starting and ambitious. In addition, our Reimbursement Specialists are horizontal thinkers, analytical, organized and detail oriented.

  • Processes provider payments in accordance with company policies and procedures.
  • Serves as primary contact to Finance Department regarding payment, determinations and payment processing activities.
  • Assist in the final determination on claim disposition and payment determination.
  • Serves as liaison to internal departments regarding provider related inquiries on claims related content.
  • Processes adjustments or provider disputes providing timely follow-up.
  • Coordinates research and responds to system inquiries from providers regarding payment, reimbursement determination, provider contact information and claims billing procedures.
  • Communicates with supervisor on a daily and/or weekly basis regarding any outstanding claims issues related to system, authorizations, reimbursement/payment errors or internal approvals.
  • Works with provider contracting staff when new/modified reimbursement contracts are needed.
  • Performs pre-adjudication claims reviews to ensure proper terms and schedules were used.
  • Initiate necessary actions regarding pending claims or payment documentation.
  • Follow up on open items reports to timely and accurate resolution.
  • Respond proactively to provider issues and concerns and give feedback to management.
  • Provide feedback to the manager regarding proper claims billing procedures in accordance with company policy and procedures.
  • Assist in training new Payment Specialists.
  • Initiate change requests to resolve system issues impacting claims/payment processing or issue resolution.
  • Runs and analyzes daily activity reports.
  • Analyze, develop and deliver claims resolutions quickly and accurately according to company policies and procedures.
  • Minimum Bachelor's degree in healthcare, business, marketing or related field; or HS Diploma (or GED) and 4 years' applicable experience.
  • Minimum 2 years of experience in previous claims, health insurance or healthcare practice.
  • Knowledge of medical coding systems (i.e., CPT, ICD-9/10, revenue codes) preferred.
  • Knowledge of commonly used medical data resources preferred.
  • Knowledge of payor contracts and interpretation.
  • Knowledge of general office operations and/or experience with standard medical insurance claim forms preferred.
  • Strong communication (verbal, written and listening), teamwork, negotiation and organizational skills.
  • Ability to commit to providing a level of customer service within established standards.
  • Ability to provide attention to detail to ensure accuracy including mathematical calculations.
  • Ability to organize workload to meet deadlines and participate in department/team meetings.
  • Ability to analyze data and arrive at a logical conclusion.
  • Ability to identify issues and determine appropriate course of action for resolution.
  • Ability to display professionalism by having a positive demeanor, proper telephone etiquette and use of proper language and tone.
  • Ability to use software and hardware related to job responsibilities, including MS Office Suite and database software.
  • Ability to work with accuracy in a fast-paced environment.
  • Ability to work independently and handle PHI and confidential information.
  • Ability to process detailed verbal and written instructions.
  • Individual in this position must be able to work in a traditional office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone.
  • Medical Insurance
  • Dental Insurance
  • Vision Insurance
  • Short & Long Term Disability
  • Life Insurance
  • 401k with company match
  • Paid Time Off
  • Paid Parental Leave
© 2024 Teal Labs, Inc
Privacy PolicyTerms of Service