As a Reimbursement Specialist, you will:
• Demonstrates excellent patient service skills, assists in problem resolution both internal and external.
• Demonstrates world class exceptional customer service and set example of correct phone etiquette.
• Promote teamwork and a positive work environment.
• Communicates to management when issues arise.
• Demonstrates an ability to differentiate between self- empowered trouble shooting issues or escalating issues to management.
• Assist with training of new team members.
• Independently problem solves and identifies opportunities for improvement.
• Completes tasks assigned in a timely and efficient manner in accordance with department policy.
• Follows up on billed and/or denied accounts with third party payers.
• Demonstrates ability to troubleshoot and escalate appropriate issues to management.
• Raises awareness of payer related trends to management with supporting data.
• Submits adjustment requests for services deemed uncollectable.
• Verifies Coordination of Benefits for all insurance provided.
• Demonstrates excellent customer service skills, assists in problem resolution both internal and external.
• Other duties as assigned.
• Establishes the payment status of billed or partially paid claims.
• Determines the root cause of denial or partially paid claim.
• Contacts payer either by phone call or online payer portal to determine if payer is requesting additional information in order to adjudicate claim.
• Obtain payment or commitment from payer to pay.
• Obtains status on billed, resubmitted, appealed and reconsideration claims.
• Determines if claim is on file.
• Files appeal after review of a denial indicates an appeal is needed or payer agrees to reprocess claim.
• Requests rebill/corrections if denial has been reviewed and it is determined that a rebill is needed.
• Contacts payer either by phone call or online payer portal if determined that a denial was inappropriate or additional information is needed for adjudication.
• Routes denial to the appropriate team after denial has been determined that another department should resolve.
• Routes claim to biller only when no claim is on file after review of the bill scrubber acceptance report.
• Transfers unpaid balance to patient once patient responsibility has been determined.
• Reviews Explanation of Benefits for clarity.
• Processes payer changes as needed.