Reimbursement Specialist

Boice-Willis • Rocky Mount, NC

11d

About The Position

This role involves verifying patient coverage, obtaining authorizations, and managing outstanding third-party claims. The specialist will evaluate payment status, resolve claim impediments by providing necessary documentation, and review account adjustments based on insurance reimbursement and services provided. Additionally, the role includes ensuring correct guarantor filing and completing assigned special projects.

Requirements

• Support co-workers and engage in positive interactions.
• Communicate professionally and timely with internal and external customers
• Demonstrate friendliness by smiling and making eye contact when greeting all customers.
• Provide helpful assistance in anticipating and responding to the needs of our customers.
• Collaborate with customers in planning and decision making to result in optimal solutions.
• Ability to stay calm under pressure and deal effectively with difficult people
• High school graduate or equivalent
• Two years of experience in a healthcare revenue cycle or clinic operations role.

Nice To Haves

• Associate’s degree in Business, Finance, Health Information Management, or related field is preferred.

Responsibilities

• Verify patient coverage information and obtain authorization for services as needed
• Accurately document all actions taken to reconcile outstanding balances
• Evaluate the payment status of outstanding third-party claims and resolve any impediments to payment by providing information such as appropriate medical records, detailed itemization of charges, information regarding other insurance benefits, and explanation of charges.
• Review and validate adjustments to accounts in the insurance portfolio based on insurance reimbursement, coverage, contracts, and services provided.
• Review charges to ensure we are filing to correct guarantor (e.g. work comp vs. personal/family)
• Complete work on special projects, queries and reports as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED