Reimbursement Specialist

Bronson Healthcare•Portage, WI

3d•Onsite

About The Position

The Reimbursement Specialist performs duties necessary to facilitate payment from third-party payers. This includes ensuring correct billing, claim status and collection, posting third-party payments when applicable, calculating correct reimbursement, processing incoming and outgoing correspondence, and maintaining working knowledge of current contracts and government regulations for multiple entities. Employees providing direct patient care must demonstrate competencies specific to the population served. The role supports compliant and accurate claims processing, resolves billing issues, prepares documentation to maximize reimbursement, and works to resolve accounts receivable, third-party liabilities, outstanding credits, and unbilled accounts. The position uses multiple internal and external computer systems and verifies insurance eligibility through automated online systems.

Requirements

High school diploma or GED required.
Successfully pass EUPAs for all Epic applications associated with the position within the first 90 days.
Strong computer and general office equipment knowledge required.
Ability to type 45 words per minute.
Effective communication with patients, customers, and coworkers.
Ability to quickly analyze communication style based on the nature and approach of a verbal inquiry.

Nice To Haves

Associate's degree in business or finance, or equivalent experience in medical billing, receivables, or collection.
Knowledge of medical terminology, ICD-10 and CPT-4 coding, National Billing forms, third-party payers, managed care, reimbursement, and regulatory compliance.

Responsibilities

Ensure claims comply with payer specifications and State, Federal, and HIPAA regulations.
Resolve billing issues early to promote better reimbursement, reduce outstanding revenue, and limit time spent on rejections and additional claim follow-up.
Prepare documentation to maximize reimbursement.
Analyze CPT-4 and ICD-10 assignments, UB04 and HCFA 1500 forms, and charges for accuracy and to maximize reimbursement from third-party payers.
Analyze and process third-party and internal information requests and rejections to resolve accounts receivable.
Analyze and process documents to resolve third-party liabilities, outstanding credits, and unbilled accounts.
Post payments, make account adjustments and refunds, and critique contractual allowances and other arrangements.
Understand and apply current contracts and government regulations, including referring matters for legal intervention for multiple entities.
Use multiple computer systems in the revenue cycle process, including EPIC, SSI, and external payer claims and eligibility systems.
Verify insurance eligibility using automated online systems.
Process incoming and outgoing correspondence and maintain working knowledge of current contracts and government regulations.