Reimbursement Specialist

MPOWERHealth • San Antonio, TX

4d

About The Position

The Reimbursement Specialist performs accounts receivable activities to maximize reimbursement for each claim. The role uses electronic medical record (EMR) and billing systems to obtain, produce, and transmit records requested by insurance carriers or other third parties. The specialist interprets explanations of benefits (EOBs), responds to denials and correspondence, and maintains clear, concise account notes and documentation.

The position also involves following up on open balances, identifying payer trends and payment changes, and coordinating with appropriate parties or departments to resolve claims and pending accounts.

Requirements

• High school diploma or GED equivalent.
• At least 2 years of medical collections experience.
• Intermediate expertise with Microsoft Office Suite, including Outlook, Excel, Word, and Teams, and PDF software such as NitroPro.
• Familiarity with insurance payer rules and regulations.
• Ability to multitask effectively.
• Strong comprehensive and analytical skills.
• Effective verbal and written communication skills, including professional phone skills.
• Detail-oriented.
• Ability to work cooperatively as a team member with a positive attitude.
• Ability to work independently with minimal supervision and maintain confidentiality.

Nice To Haves

• Previous experience working with multi-state practices.
• Previous out-of-network experience.

Responsibilities

• Understand and comply with governmental, regulatory, company billing/accounts receivable, and payer compliance requirements and policies.
• Analyze EOBs and prepare responses to insurance carriers based on claim adjudication.
• Follow up with payers and other appropriate parties to collect open balances promptly and comply with payer guidelines.
• Identify and report payer rejection trends, denial trends, or payment changes, and communicate relevant payer information to appropriate parties or departments.
• Address denials and zero payments by identifying and providing requested documentation or referring claims to billing for corrections.
• Complete follow-up tasks on pending accounts in a timely manner until each account is settled.
• Use office equipment and software applications to facilitate claim finalization.

What This Job Offers

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