Sr. Reimbursement Specialist

Fairview Health Services•Shoreview, MN

1d•Onsite

About The Position

This position will be responsible for but not limited to Medicare as a payer. This position requires great attention to detail and analytical thinking due to the complexity of Medicare/Medicaid regulations. Responsible for day-to-day functions of assigned accounts. Maintain and update billing activity. Ensure accurate and timely billing, collections, appeal of home infusion claims. Perform collection tasks to obtain payments. Generate and monitor aging reports. Analyze accounts for documentation, authorization, LCD, and all necessary information to determine the next step in the process. Provide superior customer service in person and on the phone to internal/external customers. Process third party and patient remittances, including posting payments, credits, and adjustments. Timely and accurate application of payments on third party and patient accounts. Location: Seven Lakes Pharmacy - 3650 Victoria St N Shoreview, MN Schedule: 1.0FTE Monday-Friday 8:00AM-4:30PM CST

Requirements

High School Diploma/GED
3 years medical billing or collection experience, Medicare, Medicaid, Third Party experience
Maintain current knowledge of government and private payer requirements and regulations
Attend and or complete necessary ongoing training. Pharmacy knowledge helpful
Proficient in the English language. Proficient math skills
Proficiency with PC software and A/R systems essential including basic typing skills
Ability to maintain an environment of honest and confidential communications
Ability to communicate as needed, both written and verbal information in a clear, concise, accurate and considerate manner
Ability to deal professionally, courteously, and efficiently and to remain calm under stress
Ability to assess and clarify changing priorities, Proven ability to problem-solve effectively

Nice To Haves

Vocational School Technical Training or
A.A./A.S.
5 years of Medicare billing and collections experience for home infusion
Certified Medical Billing
Pharmacy Technician MN

Responsibilities

Complete required Medicare training
Understand Medicare regulations and guidelines applicable to home infusion services
Verify Medicare Criteria using Medicare Local Coverage Determination (LCD) for covered therapies
Understand ABN and CMN/DIF processes
Utilize applicable kit codes and modifiers when billing Medicare claims
Understand Medicare appeal process and utilize correct appeal forms
Provide superior customer service, in person and on the phone, to all insurance companies, Fairview entities, and patients.
Communicate effectively, both written and verbal
Communicate appropriate information to others according to established procedures to support day-to-day operations
Process home infusion claims accurately and timely.
Review accounts for all needed information and communicate to correct departments to add information needed to ensure proper billing.
Screen claims on-line or on paper for accuracy
Obtain appropriate information to process claims
Communicate and request necessary information from payers, patients, Fairview Department
Interpret and demonstrate accurate application of third-party payer and government payer contracts.
Understand regulatory, HMO, PPO, Federal, State, and other third-party payer requirements needed to prepare and or process claims
Generate and monitor aging reports on third party payers
Communicate denials and Eligibility of Benefits (EOB’s) to insurance company and patients
Review aging reports that have reached certain aged categories (30,60,90 days, etc.)
Maintain reports to 60 days
Generate home infusion claims for resubmission for third party payer’s outstanding balances.
Perform collection tasks to obtain payments from third party payers, government, and private accounts. Negotiate payment plan arrangement with delinquent patient accounts.
Prepare and request any credit or debit adjustments
Research and refund patient or insurance company for overpayments
Request adjustments on incorrectly processed claims
Provide clear and precise documentation
Document verbal and non-verbal communication
Accurate and timely notation in computer system
Review and process correspondence
Patient orders
Rejections/denials
Medical record requests
Itemized bills
Clarification of detail on bill
Maintain and update patient accounts.
Screen claims online and or on paper for accuracy
Assist clients regarding billing questions and ensure appropriate resolution of problem(s).
Document and maintain files
Process third party payers and patient remittances
Interpret and demonstrate accurate application of third-party payer EOB's
Understand Federal, State, and other third-party payer requirements needed to prepare and process payments
Document and maintain files to support reconciliation of amount posted to amount deposited.
Post receipts within two working days after deposit.
Prepare, scan and file documents in appropriate area

Benefits

Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more! Please follow this link foradditional information: https://www.fairview.org/careers/benefits/noncontract

Stand Out From the Crowd

Upload your resume and get instant feedback on how well it matches this job.

Upload and Match Resume