Reimbursement Representative

U.S. Renal Care, Inc.•UNAVAILABLE, OH

About The Position

The Reimbursement Representative reconciles and reviews outstanding Medicare and commercial patient balances in accordance with US Renal Care reimbursement policies and procedures. The role reviews reimbursement documentation, resolves claim rejections and denials, researches insurance correspondence, follows up on unpaid balances, and takes steps to facilitate timely and accurate claims payment. Other duties and responsibilities may be assigned.

Requirements

High school diploma or GED.
At least two years of experience in a health or medical billing and collection office.
Ability to use a copier, fax machine, printer, calculator, and multi-line telephone.
Computer proficiency and an understanding of medical billing software.
Advanced knowledge of medical terminology and government and private insurer rules and regulations.
Advanced knowledge of CPT, ICD-9, and HCPCS coding, as well as in-depth knowledge of medical billing requirements.
Working knowledge of Microsoft Outlook, Word, and Excel.
Ability to use the internet, specifically Medicare and Medicaid websites.
Ability to maintain confidentiality in accordance with HIPAA rules and regulations and protect private company matters.
Ability to perform each essential duty satisfactorily.

Responsibilities

Review EOB/EOMB statements for proper reimbursement.
Resolve electronic claim rejections and Explanation of Benefits denials in a timely manner.
Review and research insurance correspondence and make necessary corrections to ensure claims payment.
Follow up on unpaid or unresolved account balances, including electronically rejected claims, EOB denials, and accounts receivable aging reports as directed; provide insurance carriers with requested information to facilitate payment.
Contact Medicare, Medicaid, and/or commercial payors to resolve claims that are unpaid or not paid according to plan benefits.
Perform claim appeals as required.
Assist with credit balance resolution.
Complete rebill requests as necessary to facilitate timely and proper claims payment.
Follow up on unresolved account balances, including RTPs.
Prepare adjustment and write-off requests as necessary.
Perform other duties and responsibilities as required or assigned.