Reimbursement Specialist

Bronson Healthcare

About The Position

Performs duties necessary to facilitate payment from third party payers. This includes correct billing, statusing and collection from third parties, posting third party payments (if applicable), computing correct reimbursement, processing incoming and outgoing correspondence, and maintaining a working knowledge of current contracts and government regulations for multiple entities. Employees providing direct patient care must demonstrate competencies specific to the population served.

Requirements

High school diploma or general education degree (GED) required.
Successfully pass EUPA's for all Epic applications associated with position within the first 90 days in the position
Strong computer and general office equipment knowledge required.
Ability to type 45 words per minute is necessary.
Must be an effective communicator with patients, customers and co-workers.
Must be able to quickly analyze communication style based on nature and approach of verbal inquiry.
Work which produces very high levels of mental/visual fatigue, e.g. CRT work between 70 and 90 percent of the time, and work involving extremely close tolerances and considerable hand/eye coordination for sustained periods of time.
The job produces some physical demands. Typical of jobs that include regular walking, standing, stooping, bending, sitting, and some lifting of light weight objects.

Nice To Haves

Associate's degree in business or Finance; or equivalent experience in Medical Billing, Receivables or Collection preferred.
Knowledge of medical terminology, ICD-10 and CPT-4 coding, National Billing forms, third-party payers, managed care, reimbursement and regulatory compliance preferred.

Responsibilities

Accountable for ensuring claims are compliant with all payer specifications; State, Federal and HIPAA regulations.
Resolves billing issues up front to promote better reimbursement, reduce outstanding revenue and time spent on working rejections or additional claim follow up.
Prepares documentation to maximize reimbursement.
Analyze assignment of all CPT-4, ICD-10, UB04, HCFA 1500 and charges for accuracy and to maximize reimbursement from third party payers
Critically analyze and process third party and internal information requests and rejections in an effort to resolve accounts receivable.
Critically analyze and process documents for resolution of third-party liabilities, outstanding credits and un-billed accounts.
Make all necessary posting, adjustments and refunds to accounts and critique contractual allowances and other arrangements.
Responsible for complete understanding and application of current contracts and governmental regulations including referrals for legal intervention for multiple entities.
Proficient in the revenue cycle process via multiple computer systems including but not limited to: Internal systems: EPIC, SSI, OnBase, and External systems such as payer claims and eligibility systems.
Verifies insurance eligibility using automated on-line systems.