Reimbursement Specialist

Boice-Willis • Rocky Mount, NC

1d

About The Position

The Reimbursement Specialist verifies patient coverage and obtains authorizations as needed. The role reviews outstanding third-party claims and works to resolve barriers to payment, including by providing supporting medical records, charge itemizations, other insurance information, and explanations of charges. It also reviews insurance-account adjustments and charges to help ensure they reflect applicable reimbursement, coverage, contracts, services, and the correct guarantor. The specialist documents actions taken to reconcile balances and completes assigned projects, queries, and reports.

The position requires professional, timely communication and positive interactions with coworkers and customers. The specialist provides helpful, customer-focused assistance, collaborates on planning and decisions to reach appropriate solutions, and remains calm when dealing with pressure or difficult people.

Requirements

• High school graduate or equivalent.
• Two years of experience in a healthcare revenue cycle or clinic operations role.
• Ability to communicate professionally and promptly with internal and external customers.
• Ability to stay calm under pressure and deal effectively with difficult people.

Nice To Haves

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

Responsibilities

• Verify patient coverage information and obtain authorization for services as needed.
• Accurately document actions taken to reconcile outstanding balances.
• Evaluate the payment status of outstanding third-party claims and resolve impediments to payment by supplying relevant information, such as medical records, itemized charges, other insurance benefits, and explanations of charges.
• Review and validate insurance-portfolio account adjustments based on reimbursement, coverage, contracts, and services provided.
• Review charges to ensure they are filed to the correct guarantor, such as workers’ compensation versus personal or family coverage.
• Complete assigned special projects, queries, and reports.
• Support coworkers and engage in positive interactions.
• Communicate professionally and promptly with internal and external customers.
• Anticipate and respond helpfully to customer needs, and collaborate with customers on planning and decision-making to achieve optimal solutions.
• Remain calm under pressure and deal effectively with difficult people.

What This Job Offers

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