Reimbursement Specialist
About The Position
MPOWERHealth is seeking a Reimbursement Specialist to support medical claims reimbursement and collections. The role focuses on following up with insurance carriers, resolving denied or deficient claims, and expediting payments. The specialist reviews explanations of benefits, prepares and submits reconsideration requests and formal appeals, negotiates claims, processes rebills, and provides management with information about problematic payors and potential solutions. The position also involves communicating with patients, colleagues, professional offices, and other internal and external customers while handling sensitive information appropriately.
Requirements
- At least 2 years of medical collections experience.
- High school diploma or equivalent required.
- Ability to read and understand an explanation of benefits (EOB).
- Ability to spell accurately, use good grammar, and write appeal letters.
- Knowledge of CPT and/or ICD-10.
- Knowledge of legal and regulatory government provisions.
- Knowledge of laws regulating communication and privacy, including HIPAA and its application.
- Medical terminology knowledge.
- Strong interpersonal and tactful communication skills when dealing with patients, coworkers, and other professional offices.
- Discretion, problem-solving, troubleshooting, and organizational skills.
- Ability to perform essential duties with or without accommodations.
Responsibilities
- Appeal denied and deficient claims, including writing appeal letters.
- Contact and follow up with insurance carriers regarding denials; file reconsideration requests, formal appeals, and negotiations.
- Aggressively follow up with insurance companies to collect outstanding payments.
- Obtain the status of outstanding claims and follow up on outstanding accounts-receivable balances assigned by a supervisor or manager.
- Ensure timely and accurate processing of rebills to the appropriate insurance companies.
- Interact with internal and external customers to resolve problems and expedite payments.
- Provide detailed information about problem payors to management and suggest solutions.
- Participate in educational activities and report needed information to the Collections Manager.
- Perform fast, accurate data entry and manage multiple priorities.
Benefits
- Multiple medical plan options.
- Health Savings Account with company contributions.
- Dental and vision coverage for employees and dependents.
- 401(k) with company match.
- Vacation, sick time, and company-paid holidays.
- Company wellbeing program with health insurance incentives.
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
