Reimbursement Specialist- Onsite

Bronson Healthcare Group•Portage, MI

6d•Onsite

About The Position

The Reimbursement Specialist performs duties necessary to facilitate payment from third-party payers. This includes ensuring correct billing, claim status and collection, posting third-party payments when applicable, calculating reimbursement, processing correspondence, and maintaining working knowledge of current contracts and government regulations for multiple entities. The role is accountable for claim compliance with payer specifications and State, Federal, and HIPAA regulations. It resolves billing issues to improve reimbursement and reduce outstanding revenue and claim follow-up, and prepares documentation to maximize reimbursement. The specialist analyzes billing assignments, codes, and charges for accuracy; processes payer and internal requests, rejections, and documents related to accounts receivable; and makes postings, adjustments, and refunds while reviewing contractual allowances and other arrangements. The position requires applying contracts and government regulations, including referrals for legal intervention when needed. It also involves working in multiple revenue-cycle systems and verifying insurance eligibility through automated online systems. This is an onsite, full-time first-shift position at Bronson's Business Office Building at 6901 Portage Road in Portage, 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.
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 a verbal inquiry.
Ability to perform work involving sustained computer/visual activity and close hand-eye coordination.
Ability to meet the position's physical demands, including regular walking, standing, stooping, bending, sitting, and some lifting of light objects.

Nice To Haves

Associate degree in business or finance, or equivalent experience in medical billing, receivables, or collections.
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 State, Federal, and HIPAA regulations.
Resolve billing issues promptly to improve reimbursement and reduce outstanding revenue and time spent on rejections or follow-up.
Prepare documentation to maximize reimbursement.
Analyze CPT-4, ICD-9, 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 and make necessary account adjustments and refunds; review contractual allowances and other arrangements.
Apply current contracts and governmental regulations for multiple entities, including referrals for legal intervention when needed.
Use multiple internal and external computer systems to perform revenue-cycle work.
Verify insurance eligibility using automated online systems.
Process incoming and outgoing correspondence and maintain knowledge of current contracts and government regulations.