Hybrid/On Site - Bend, Oregon, Specialist, Reimbursement

Summit Health CityMD•Bend, OR

2d•$22 - $24•Hybrid

About The Position

Hybrid/On Site - Bend Oregon The Reimbursement Specialist is responsible for claim management, denial management and aged unpaid claim follow up. Responsible for processing insurance claims for various types of insurance and maximizing SMGOR reimbursement. Responsible for claim resolution through working claims edits and appealing denied claims in a timely manner. Track status of outstanding claims, follow up on outstanding AR balances and monitoring of payer response. Provide detailed information regarding problem payers to management; provide suggestions for solutions to management.

Requirements

High School Graduate/GED required.
Ability to communicate effectively, both orally and in writing required.
Strong attention to detail and customer service skills required.
Strong problem solving and decision making skills required.
Experience with PM/EMR.
Experience with Standard Office Technology in a Window based environment; including experience with Microsoft Office, Word and Excel required.
Experience with Standard Office Equipment (Phone, Fax, Copy Machine, Scanner, Email/Voice Mail) required.
Familiar with modifiers, CPT, diagnoses, credentialing process and State and Federal insurance laws.

Nice To Haves

Associate’s degree preferred.
Two years medical office or billing experience preferred.

Responsibilities

Monitoring and working in the work queues for assigned providers and specialties, to include researching and correcting claims, writing appeals and facilitating their submission for appealing adverse decisions, contacting payers as needed, and all other activities that lead to the successful adjudication of eligible claims.
Any payer specific coding and charge entry based on assigned providers and specialties.
Completing claims worklists assigned by Reimbursement Supervisor.
Complete system knowledge to include credit work queues.
Have the ability to research and resolve overpayments for insurance and self-pay.
Responsible for monitoring contractual allowances.
Reviews and analyzes EOBs for identified under allowed claims.
Researches and resolves billing errors including resubmission of claims to insurance companies.
Make any necessary corrections/refunds.
Compiles and submits appeals, and monitors for proper reimbursement according to current contract
Provide CPT and contract analysis reports as requested
Field Patient Accounts staff or practice-based patient balance due questions and complaints as well as insurance needs on behalf of assigned providers and specialties.
Receive transferred calls or emails from Patient Accounts staff from insurance companies requesting advanced assistance with their patient account.
Illustrate excellent knowledge of healthcare industry in regard to the revenue cycle, coding, claims and state insurance laws.
Perform payment posting and charge entry as needed.
Proficient in EMR/EHR.
Proficient in management and resolution of items in the work queues
Rules versus denials
Claim edits: what they are and what they do.
Claim note history including actions and claim statuses
Payer Rejections
Utilizing and managing payer websites
Sorting in work queue to prioritize daily as assigned
Proficient in explanation of benefits (EOBs) and electronic remittance advice (ERA) reason and remark codes provided by the payers.
Proficient in working claim edit work lists
Claim attachment
Corrected claim attachment
Payer specific edit
Exhibit strong communication skills with internal players including physicians, providers, peers, and your supervisor/manager
Exhibit strong communication skills in claim notation, appeals and payers.
Understanding of generally accepted insurance benefit terms and processes
Understanding of Documents Table, Registration, and Claim Edit screens. All screens, tools and data locations available under the user’s security access.
Understanding of request/preparation of supporting documentation such as medical records, dictation, appeal letters, contract pages.
Understanding of patient balance policies, workflows, and tools.
Understanding of investigation and Denial/Appeal/Preparation of refunds for both the Patient and Insurance.