Reimbursement Specialist- Comm/Mgd Care- Onsite

Bronson Healthcare•Portage, WI

11d•Onsite

About The Position

Performs duties necessary to facilitate payment from third-party payers. The role includes ensuring correct billing, claim status and collection, posting third-party payments when applicable, calculating correct reimbursement, processing 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 specialist works to ensure claims comply with payer specifications and applicable state, federal, and HIPAA regulations; resolve billing issues; prepare documentation to maximize reimbursement; analyze coding and charges for accuracy; and process requests, rejections, account adjustments, refunds, credits, liabilities, and unbilled accounts. The role also requires applying current contracts and governmental regulations, using multiple internal and external revenue-cycle systems, and verifying insurance eligibility through 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 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 up front to promote reimbursement and reduce outstanding revenue and follow-up work.
Prepare documentation to maximize reimbursement.
Analyze CPT-4, ICD-10, UB04, HCFA 1500 assignments and charges for accuracy and reimbursement opportunities.
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 referrals for legal intervention for multiple entities.
Use internal and external computer systems to perform revenue-cycle work.
Verify insurance eligibility using automated online systems.
Process incoming and outgoing correspondence and facilitate third-party payment and collection.