Reimbursement Specialist- Comm/Mgd Care- Onsite

Bronson Healthcare Group•Portage, MI

10d•Onsite

About The Position

The Reimbursement Specialist performs duties to facilitate payment from third-party payers, including accurate billing, claim status follow-up and collection, posting payments when applicable, calculating reimbursement, processing correspondence, and maintaining current knowledge of contracts and government regulations for multiple entities. The role ensures claims comply with payer specifications and applicable state, federal, and HIPAA requirements. It resolves billing issues, prepares documentation to maximize reimbursement, analyzes coding and charge assignments, processes requests, rejections, liabilities, credits, and unbilled accounts, and makes account postings, adjustments, and refunds. The specialist also applies current contracts and regulations, uses multiple revenue-cycle systems, and verifies insurance eligibility through online systems. This is a full-time, first-shift, onsite position at the Business Office Building, 6901 Portage Road, Portage, Michigan, with 40 scheduled weekly hours. The work involves substantial computer and visual activity, as well as regular walking, standing, stooping, bending, sitting, and occasional lifting of light objects.

Requirements

High school diploma or GED required.
Successfully pass EUPAs for all Epic applications associated with the position within the first 90 days.
Strong computer skills and knowledge of general office equipment.
Ability to type 45 words per minute.
Effective communication with patients, customers, and coworkers.
Ability to quickly analyze communication style based on the nature and approach of verbal inquiries.

Nice To Haves

Associate degree in business or finance, or equivalent experience in medical billing, receivables, or collections.
Knowledge of medical terminology, ICD-10 and CPT-4 coding, national billing forms, third-party payers, managed care, reimbursement, and regulatory compliance.

Responsibilities

Facilitate payment from third-party payers through accurate billing, claim status follow-up, collection, payment posting when applicable, and reimbursement calculation.
Process incoming and outgoing correspondence and maintain working knowledge of current contracts and government regulations for multiple entities.
Ensure claims comply with payer specifications and state, federal, and HIPAA regulations.
Resolve billing issues early to improve reimbursement, reduce outstanding revenue, and limit work on rejections and claim follow-up.
Prepare documentation to maximize reimbursement.
Analyze CPT-4, ICD-10, UB04, HCFA 1500, and charge assignments for accuracy and reimbursement potential.
Analyze and process third-party and internal information requests and rejections to resolve accounts receivable.
Analyze and process documents to resolve third-party liabilities, outstanding credits, and unbilled accounts.
Post transactions, make account adjustments and refunds, and critique contractual allowances and other arrangements.
Understand and apply current contracts and governmental regulations, including referrals for legal intervention when needed.
Use multiple internal and external revenue-cycle computer systems.
Verify insurance eligibility using automated online systems.