Reimbursement Specialist

Bronson Healthcare•Portage, WI

3d•Onsite

About The Position

The Reimbursement Specialist performs duties necessary to facilitate payment from third-party payers. Work includes ensuring correct billing, claim status and collection; posting third-party payments when applicable; calculating correct reimbursement; processing incoming and outgoing correspondence; and maintaining working knowledge of current contracts and government regulations for multiple entities. The role also verifies insurance eligibility through automated online systems and works across internal and external revenue-cycle systems. Employees providing direct patient care must demonstrate competencies specific to the population served.

Requirements

High school diploma or GED required.
Successfully pass EUPAs for all Epic applications associated with the position within the first 90 days in the position.
Strong computer skills and knowledge of general office equipment required.
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 a verbal inquiry.

Nice To Haves

Associate degree in business or finance, or equivalent experience in medical billing, receivables, or collection.
Knowledge of medical terminology, ICD-9 and CPT-4 coding, national billing forms, third-party payers, managed care, reimbursement, and regulatory compliance.

Responsibilities

Ensure claims comply with payer specifications and applicable state, federal, and HIPAA regulations.
Resolve billing issues proactively to improve reimbursement and reduce outstanding revenue and follow-up work on rejections or claims.
Prepare documentation to maximize reimbursement.
Analyze CPT-4 and ICD-9 assignments, UB04 and HCFA 1500 forms, and charges 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 payments, make account adjustments and refunds, and critique contractual allowances and other arrangements.
Understand and apply current contracts and governmental regulations, including referring matters for legal intervention when necessary.
Use multiple internal and external computer systems to perform revenue-cycle work.
Verify insurance eligibility using automated online systems.
Process third-party payments when applicable and maintain working knowledge of contracts and regulations for multiple entities.