Reimbursement Specialist I
3.
4 Lakewood, WA Lakewood, WA Full-time Full-time $19 - $21 an hour $19 - $21 an hour 2 days ago 2 days ago 2 days ago Overall
Responsibilities:
Assists in coordinating and maintaining the reimbursement program to ensure compliance with current payments, rules and legislative regulations that impact billing and collections.
Monitors and evaluates current reimbursement/payment rules and policy guidelines to ensure that legislative and regulatory changes impacting medical billing are anticipated and communicated to the company.
Ensures adherence to all HIPAA, JCAHO, and Compliance rules and regulations.
Reviews authorization, detailed prescriptions, and verification for claims within his/her work group, to ensure that accurate claims were submitted for revenue and their medical necessity in the event the services were not paid accurately.
Works towards minimizing AR within assigned workgroup by correcting and resubmitting claims, as well as submitting appeals.
Communication with various insurance companies and payers to resolve billing and reimbursement discrepancies.
Reviews information provided by payers regarding the reimbursement for goods and services, usually on an Explanation of Benefits (EOB) or Remittance Advice, to ensure posting of payments align with these documents and reason for non-payment or inaccurate reimbursement.
Trend identification should be performed through this process and escalated to management for global resolution.
Confirms and prioritizes pick-ups, exchanges, and returns on both serialized and non-serialized equipment and supplies to ensure inventory and other functional operating areas are not negatively affected.
Ensures that claims are followed up in a timely manner, specifically no longer than payer requirements, to avoid write-offs.
Requesting adjustments, write-offs, or refunds from manager on balances over $1,000.
00.
Responds to customer inquiries both in person and telephonically as necessary, including but not limited to payments on account, questions about benefits, and questions about insurance policy.
Prepares and submits medical records to the various payers on request to facilitate payment for services or audit.
Meet or exceed Key Performance Indicators (KPIs) and productivity in all measured areas.
Performs other duties, as assigned by management.
Minimum
Qualifications:
Competent level of experience in medical billing (2-3 years minimum), experience in Brightree and/or DME preferred.
A background in healthcare related industry experience required.
Must be knowledgeable of insurance requirements, policy guidelines, and have the ability to determine medical justification by reviewing documentation to ensure proper reimbursement.
Ability to effectively operate billing software and patient portal to cover the scope of his/her job description.
Ability to type over 30 WPM and navigate computer programs accurately and efficiently.
Continuing Education:
Attends educational workshops as assigned Reviews pertinent industry literature including reimbursement issues HIPAA Training.
Estimated Salary: $20 to $28 per hour based on qualifications.
4 Lakewood, WA Lakewood, WA Full-time Full-time $19 - $21 an hour $19 - $21 an hour 2 days ago 2 days ago 2 days ago Overall
Responsibilities:
Assists in coordinating and maintaining the reimbursement program to ensure compliance with current payments, rules and legislative regulations that impact billing and collections.
Monitors and evaluates current reimbursement/payment rules and policy guidelines to ensure that legislative and regulatory changes impacting medical billing are anticipated and communicated to the company.
Ensures adherence to all HIPAA, JCAHO, and Compliance rules and regulations.
Reviews authorization, detailed prescriptions, and verification for claims within his/her work group, to ensure that accurate claims were submitted for revenue and their medical necessity in the event the services were not paid accurately.
Works towards minimizing AR within assigned workgroup by correcting and resubmitting claims, as well as submitting appeals.
Communication with various insurance companies and payers to resolve billing and reimbursement discrepancies.
Reviews information provided by payers regarding the reimbursement for goods and services, usually on an Explanation of Benefits (EOB) or Remittance Advice, to ensure posting of payments align with these documents and reason for non-payment or inaccurate reimbursement.
Trend identification should be performed through this process and escalated to management for global resolution.
Confirms and prioritizes pick-ups, exchanges, and returns on both serialized and non-serialized equipment and supplies to ensure inventory and other functional operating areas are not negatively affected.
Ensures that claims are followed up in a timely manner, specifically no longer than payer requirements, to avoid write-offs.
Requesting adjustments, write-offs, or refunds from manager on balances over $1,000.
00.
Responds to customer inquiries both in person and telephonically as necessary, including but not limited to payments on account, questions about benefits, and questions about insurance policy.
Prepares and submits medical records to the various payers on request to facilitate payment for services or audit.
Meet or exceed Key Performance Indicators (KPIs) and productivity in all measured areas.
Performs other duties, as assigned by management.
Minimum
Qualifications:
Competent level of experience in medical billing (2-3 years minimum), experience in Brightree and/or DME preferred.
A background in healthcare related industry experience required.
Must be knowledgeable of insurance requirements, policy guidelines, and have the ability to determine medical justification by reviewing documentation to ensure proper reimbursement.
Ability to effectively operate billing software and patient portal to cover the scope of his/her job description.
Ability to type over 30 WPM and navigate computer programs accurately and efficiently.
Continuing Education:
Attends educational workshops as assigned Reviews pertinent industry literature including reimbursement issues HIPAA Training.
Estimated Salary: $20 to $28 per hour based on qualifications.
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