Insurance Reimbursement Specialist

in Maitland
, FL
Reference: 19-01957

General Summary:

Actively participate in outstanding customer service and accept responsibility in maintaining relationships that are equally respectful to all. Under general supervision, is responsible for processing insurance and billing insurance in a timely manner. Review assigned electronic claims and submission reports. Resolve and resubmit rejected claims appropriately as necessary. Process daily and  special reports, unlisted invoices and letters, error logs, stalled reports and aging. Perform outgoing calls to patients and insurance companies to obtain necessary information for accurate billing. Answer incoming calls from insurance companies requesting additional information and/or checking status of billings. Adhere to all company policies and procedures. Adhere to our client’s corporate compliance plan and to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies.

Knowledge and Skill Required

  • Ability to use discretion when discussing personnel/patient related issues that are confidential in nature
  • Ability to be responsive to ever-changing matrix of hospital needs and act accordingly
  • Typing skills equal to 20 words per minute net
  • Proficiency in performance of basic math functions
  • Ability to communicate professionally and effectively in English, both verbally and in writing
  • Proficiency in Microsoft Office products such as Word and Excel
  • Strong analytical and research skills

Education and Experience Required

  • 1 year of experience in revenue cycle department or related area (registration, finance, collections, customer service, medical, contract management)

Preferred Education and Experience:

  • High School diploma or GED

Principal Duties and Responsibilities:

  • Work with insurance payors to ensure proper reimbursement on patient accounts
  • Depending on payor contract may be required to participate in conference calls, accounts receivable reports, compiles the issue report in order to expedite resolution of accounts
  • Examine contract to ensure proper reimbursement, educates team of inconsistencies in processing, including disciplinary discussions if necessary, and any changes to contract identified
  • Work follow up report daily, maintaining established goal(s), and notify supervisor of issues preventing achievement of such goal(s)
  • Follow up on daily correspondence (denials, underpayments) to appropriately work patient accounts
  • Assist customer service with patient concerns/questions to ensure prompt and accurate resolution is achieved
  • Produce written correspondence to payors and patients regarding status of claim, requesting additional information, etc.
  • Review previous account documentation, determining appropriate action(s) necessary to resolve each assigned account
  • Initiate next billing, follow-up and/or collection step(s), this is not limited to calling patients, insurers or employers, as appropriate
  • Send initial or secondary bills to insurance companies
  • Document billing, follow-up and/or collection step(s) that are taken and all measures to resolve assigned accounts, including escalation to supervisor/manager if necessary
  • Process administrative and medical appeals, refunds, reinstatements and rejections of insurance claims
  • Remain in consistent daily communication with team members, including new process education, disciplinary actions, Reimbursement Lead and Reimbursement Manager regarding all aspects of assigned projects
  • Monitor and assist team members regularly, providing feedback, ensuring both goals and job requirements are met as assigned by Manager
  • Train new staff, perform audits of work performed, and communicate progress to appropriate supervisor
  • Provide continuing education of all team members on process and A/R requirements
  • Adhere to HIPAA regulations by verifying pertinent information to determine caller authorization level receiving information on account