Reimbursement Escalation Specialist (Revenue Cycle)

Koninklijke Philips N.V • Plymouth, MA

275d • $34 - $55 • Onsite

About The Position

As a Reimbursement Escalation Specialist you will analyze, problem solve and reconcile new and aging claims. Your role includes escalating, tracking and reporting on reimbursement trends to the Revenue Cycle Management team on a daily, weekly and monthly basis. You will work with insurance carriers to clarify issues related to claims and manage payer prepayment audits. Additionally, you will address inquiries or requests for help in resolving complicated or escalated claims from cross-functional teams, which includes Cash Application Specialists, Payer Relations, Patient Collections, and Reimbursement. You will review and approve claims adjustment requests to validate all collection actions from work instruction have been followed, while also ensuring claims processing steps, appeals, credits and refunds are compliant with specific payer requirements. Building positive relationships with operations and collection teams to minimize claims payment turnaround time is also a key part of your role. You will communicate with patients regarding outstanding balances and establish and approve payment plans.

Requirements

• 4+ years of experience in medical claims billing or collections.
• 1+ years in a lead or supervisory role within Revenue Cycle Management.
• Knowledge of insurance payers, including Medicare, Medicaid, Blue Cross Blue Shield and commercial plans.
• Experience managing denials, claim appeals and claim recoupments.
• Knowledge of eligibility of benefits and authorizations.
• High school diploma or GED (required) or equivalent work experience.

Nice To Haves

• Strong written and verbal communication skills.

Responsibilities

• Analyze, problem solve and reconcile new and aging claims.
• Escalate, track and report on reimbursement trends to the Revenue Cycle Management team.
• Work with insurance carriers to clarify issues related to claims.
• Manage payer prepayment audits.
• Address inquiries or requests for help in resolving complicated or escalated claims.
• Review and approve claims adjustment requests.
• Ensure claims processing steps, appeals, credits and refunds are compliant with specific payer requirements.
• Build positive relationships with operations and collection teams.
• Communicate with patients regarding outstanding balances and establish payment plans.

Benefits

• Generous PTO.
• 401k (up to 7% match).
• HSA (with company contribution).
• Stock purchase plan.
• Education reimbursement.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Ambulatory Health Care Services
• Education Level: High school or GED