Reimbursement Specialist

Bronson Healthcare Group•Portage, MI

1d•Onsite

About The Position

The Reimbursement Specialist performs duties to facilitate payment from third-party payers, including accurate billing, claim status follow-up and collection, payment posting when applicable, reimbursement calculation, correspondence processing, and maintaining working knowledge of current contracts and government regulations for multiple entities. The role helps ensure claims meet payer requirements and applicable state, federal, and HIPAA regulations, and works to resolve billing issues early to improve reimbursement and reduce outstanding revenue and follow-up work. The specialist analyzes billing assignments and charges, processes payer and internal information requests and rejections, resolves accounts receivable and third-party liabilities, addresses outstanding credits and unbilled accounts, and makes necessary account postings, adjustments, and refunds. The position requires understanding and applying current contracts and government regulations, including referrals for legal intervention when needed. It uses multiple internal and external revenue-cycle systems and verifies insurance eligibility through automated online systems. The role is based at the Business Office Building at 6901 Portage Road in Portage. It is a full-time, first-shift position scheduled for 40 hours per week. Work involves substantial computer and close visual activity, along with regular walking, standing, stooping, bending, sitting, and some lifting of light objects.

Requirements

High school diploma or GED.
Pass EUPAs for all Epic applications associated with the position within the first 90 days in the position.
Strong computer skills and knowledge of general office equipment.
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 verbal inquiries.
Ability to perform work involving sustained computer/CRT use, close visual tolerances, and hand-eye coordination.
Ability to perform regular walking, standing, stooping, bending, and sitting, and lift light-weight objects.

Nice To Haves

Associate degree in business or finance, or equivalent experience in medical billing, receivables, or collections.
Knowledge of medical terminology, ICD-9 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 reimbursement, reduce outstanding revenue, and limit work on rejections and additional claim follow-up.
Prepare documentation to maximize reimbursement.
Analyze CPT-4, ICD-9, UB04, HCFA 1500 assignments, and charges for accuracy and reimbursement potential.
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 and make necessary account adjustments and refunds; critique contractual allowances and other arrangements.
Understand and apply current contracts and governmental regulations, including making referrals for legal intervention when necessary.
Use multiple internal and external computer systems to perform revenue-cycle work.
Verify insurance eligibility using automated online systems.
Process incoming and outgoing correspondence and, when applicable, post third-party payments and calculate reimbursement.