Reimbursement Specialist

Bronson Healthcare Group•Portage, MI

2d•Onsite

About The Position

The Reimbursement Specialist performs duties to facilitate payment from third-party payers. Work includes ensuring correct billing, claim status and collection, posting third-party payments when applicable, calculating reimbursement, processing correspondence, and maintaining knowledge of current contracts and government regulations across multiple entities. The role is accountable for compliant claims and works to resolve billing issues early to improve reimbursement and reduce outstanding revenue and claim follow-up. The position is based at Bronson's Business Office Building in Portage, Michigan, and is full-time, first shift, with 40 scheduled hours per week.

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 collections.
Knowledge of medical terminology, ICD-10 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 up front to promote better reimbursement, reduce outstanding revenue, and limit work on rejections or additional claim follow-up.
Prepare documentation to maximize reimbursement.
Analyze CPT-4, ICD-10, UB04, HCFA 1500 assignments 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 appropriate.
Use multiple computer systems for revenue-cycle work, including EPIC, SSI, and external payer claims and eligibility systems.
Verify insurance eligibility using automated online systems.
Process incoming and outgoing correspondence.