What Does a Reimbursement Specialist Do?
A reimbursement specialist ensures that healthcare providers and organizations are appropriately reimbursed for their services. They are responsible for verifying insurance coverage, submitting reimbursement claims, and communicating with insurance companies, patients, and healthcare providers. In addition, they must stay up-to-date with changes in insurance policies and regulations that may affect reimbursement procedures.
Reimbursement specialists must have an in-depth understanding of healthcare billing and coding processes. Also, they should be able to understand and navigate complicated insurance policies and regulations. Communication skills and the ability to work with a variety of stakeholders, including insurers, patients, and healthcare providers, are also critical.
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National Average Salary
Reimbursement specialist salaries vary by experience, industry, organization size, and geography. To explore salary ranges by local market, please visit our sister site zengig.com.
The average U.S. salary for a Reimbursement Specialist is:
Reimbursement Specialist Job Descriptions
When it comes to recruiting a reimbursement specialist, having the right job description can make a big difference. Here are some real world job descriptions you can use as templates for your next opening.
Reimbursement specialists are responsible for communicating and working with insurance companies and medical billing staff to manage billing and various reimbursements. This position requires an advanced understanding of records, coding, and billing practices to ensure compliance and patient confidentiality. If you want to be in a medical setting where you don’t have to be up and running, becoming a reimbursement specialist may be the right career for you. [Your Company Name] is searching for a compassionate reimbursement specialist that has a gift for working with others by listening and trying to fulfill their needs to their best abilities. If you have been in a previous insurance role and have strong organization skills, you may be the perfect candidate to fulfill our open position as a reimbursement specialist.
Typical duties and responsibilities
- Process claims quickly and accurately to ensure there are no errors
- Update patient medical files
- Investigate claims issues and make recommendations for process improvement
- Understand insurance carrier guidelines and stay abreast of any changes that occur to communicate them to management and staff
- Adhere to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient’s records
Education and experience
This position requires a high school diploma or GED.
Required skills and qualifications
- Understand medical terminology, accounts receivable, insurance collections, and billing
- Expertise in written and verbal communication
- Ability to think independently
- Excellent interpersonal skills
- Ability to recognize and deal with priorities
- 2 years of experience in a call center/customer service-oriented role that requires attention to detail and basic computer skills
- General knowledge of benefits, healthcare, medical/pharmacy insurance is a huge plus
Responsible for the timely, accurate submission of invoices to the responsible payer, of any type, for all services and products provided. Evaluates payments received and applied to the patient account. Follows up with responsible parties to ensure the receipt of timely, accurate payments. Assists with Billing and Collection Training and completes “second-level” appeals to payers.
- Submits timely, accurate invoices to payer for products and services provided. Understands the terms and fee schedule for all contracts for which invoices are submitted. Correctly determines quantities and prices for drugs billed. Verifies that the services and products are correctly authorized and that required documentation is on file. Ensures that invoices are submitted for services and products that are properly ordered and confirmed as provided.
- Evaluates payments received for correctness and applies payments accurately to the system. Verifies that payments received are correct according to the fee schedule. Applies the payment correctly to the patient account. Ensures that secondary bills and patient invoices are mailed within 48 hours of receipt of payment. Notifies the Reimbursement Manager if there are overpayments and/or duplicate payments for the same service. Transfers payments belonging to other offices within 48 hours of receipt.
- Follows up on invoices submitted to ensure prompt and timely payment. Calls to verify that claims submitted were received and are in processing. Sends letters to the patient or responsible party when their insurance carrier fails to make payment reasonable time frame. Generates and mails statements and collections letters. Follows up on all denials within 48 hours of receipt.
- Ensures compliance with policies and guidelines outlined in the contract terms and fee schedule. Follows HIPPA guidelines when accessing and sharing patient information to maintain patient and business confidentiality.
Basic education and experience requirements
- High School Diploma or equivalent
- 0 – 6 months previous Infusion Reimbursement or Intake/Admissions experience
- Basic level skill in Microsoft Excel (for example: opening a workbook, inserting a row, selecting font style and size, formatting cells as currency, using copy, paste and save functions, aligning text, selecting cells, renaming a worksheet, inserting a column, selecting a chart style, inserting a worksheet, setting margins, selecting page orientation, using spell check, and/or printing worksheets).
- Basic level skill in Microsoft Word (for example: opening a document, cutting, pasting and aligning text, selecting font type and size, changing margins and column width, sorting, inserting bullets, pictures and dates, using find and replace, undo, spell check, track changes, review pane, and/or print functions).
How have you impacted someone’s life today? At ABC company our teams are focused on changing the lives of our patients by providing the highest level of care each and every day. From our hospitals, rehab centers, and occupational health teams to our long-term care centers and at-home care capabilities, our complete spectrum of services will allow you to apply your skills in multiple settings while building your career.
- Assistance in the preparation of the Medicare and Chapter 160 cost reports by completing basic sections under supervision
- Quarterly coordination and accumulation of physician time studies
- Coordination and accumulation of statistical data
- Coordination and accumulation of Interns & Resident’s schedules and all required personal data
- Coordination and accumulation of all Direct Patient Care Contracted Labor & Administrative Contracted Labor
- Software input of the cost report data, as needed
- Performance of financial analysis of relevant reimbursement issues as they arise
- Preparation of the Hospice cost report with supervision
- Related sections of applicable monthly/yearly surveys. Other duties as assigned by Management
- Bachelor’s degree or equivalent experience in Finance, Accounting, and/or Economics with GPA above 3.0
- Possesses beginning to working knowledge of hospital reimbursement experience, including preparation of cost reports
- Demonstrated proficiency in Microsoft Excel and Word
- Effective written and verbal communication skills
- One or more years hospital reimbursement experience, including preparation of cost reports
We are looking for an Insurance Reimbursement Specialist. The Insurance Reimbursement Specialist is responsible for collecting on all outstanding balances for a specific group of payers to assure maximum reimbursement.
- Works aged accounts 30-120 days, processes appeals or corrected claims, researches and reconciles credit balance accounts, and processes adjustments as needed
- Interacts with patients, clinicians, insurers, Reimbursement Supervisor, and Billing management to ensure timely collection of accounts
- Participates in the Quality Assurance plan
- Complies with applicable CLIA and HIPAA regulations
- 3-5 years of experience working in medical billing, health insurance, or collections with demonstrated results
- Insurance billing experience is preferred
- High School diploma or GED required
- Good problem-solving and decision-making skills
- Time management skills are a must
- Excellent customer service and phone skills
- Excellent organizational, communication, multitasking, and teamwork skills
- Working knowledge of ICD-10, CPT, and HCPCS coding (preferred but not required)
Candidate Certifications to Look For
- Certified Professional Biller (CPB). The Certified Professional Biller prepares its students to become expert medical billers. The course provides all the resources needed to learn how to properly submit claims, follow up on claim statuses, resolve claim denials, submit appeals, and make adjustments while always adhering to government regulations. Earning this certification would be the best next step to furthering a candidate’s career as a reimbursement specialist once they graduate high school or earn their GED.
- Certified Billing and Coding Specialist (CBCS). Having basic coding skills is essential to becoming a reimbursement specialist. This certification will teach proper medical coding, so candidates learn how to properly submit medical claims with specific diagnostic codes required for correct payments. The course also teaches how to prevent fraud by understanding how to audit billing. The CBCS not only teaches valuable skills each reimbursement specialist needs, but also how to achieve optimal reimbursements by negotiating with insurance companies and healthcare providers. Becoming a certified billing and coding specialist will make candidates competitive applicants and desirable to many firms!
How to Hire a Reimbursement Specialist
Consider the following when hiring a reimbursement specialist:
- Recruiting: Do you have the internal resources and tools to source and recruit for this role successfully?
- Complexity: Do you need a senior professional, or will mid, or even junior-level skills suffice?
- Duration: Is this a one-time project, or an indefinite need?
- Management: Can you effectively direct the work effort?
- Urgency: Are there any deadlines associated with this need?
- Headcount: Do you have the budget and approval for an internal employee, or should you consider alternate options?
Answering these questions will help determine the best course of action for your current hiring need. Fortunately, various great options exist for every scenario, no matter how unique. We recommend the following options when hiring a reimbursement specialist:
1. Use 4 Corner Resources (or another professional recruiting firm)
The heavy lifting is done for you when working with a top-tier staffing company like 4 Corner Resources. We source, screen, recruit, and deliver only the most qualified candidate(s), saving you significant time and effort throughout the hiring process while you remain focused on your core business. Understanding your needs and ensuring the right candidate for the position is the key to our success.
This is the best route to take when:
- You need to fill the position quickly
- You want access to a vast talent pool of high-quality, prescreened candidates
- Your position is suited for temporary hiring services, contract staffing, or contract-to-hire recruiting, and you intend to direct the work activity.
- You are hiring an employee as a direct placement but aren’t able to recruit effectively or efficiently with your internal staff.
- You aren’t familiar with current salary rates, market trends, and available skill sets
2. Advertise your opening on a top job board
Your best option may be to advertise your opening on a proven job board. There are many widely used job sites out there that draw visits from qualified candidates. If you have someone internally who can dedicate the time and energy to sort through applications and screen individuals effectively, this can be a great choice.
We recommend using a job board when:
- Your internal recruiting team has the knowledge and experience to assess candidate qualifications
- You are hiring a direct employee and have time to manage the entire recruiting effort
- You have a process for receiving, screening, and tracking all resumes and applications
- You are prepared to respond to all applicants
We recommend CareerBuilder when hiring a reimbursement specialist:
CareerBuilder has been a trusted source for hiring since 1995. Reach 80+ million unique, diverse U.S. job seekers annually by posting your jobs through their talent acquisition channels. Through CareerBuilder, you can engage candidates and drive them into your sourcing pipeline. We recommend using CareerBuilder for hiring when you have the internal resources and processes to review, screen, and reply to all applicants.
3. Leverage your internal resources
You can utilize your own website, social media, and employees to assist in your search for top candidates.
A company website posting should be the first step in notifying prospective candidates that you are hiring. Social media can also be a powerful tool for spreading the word about your new opening. As far as exposure is concerned, this option can be as good as some job boards when you have a large enough following across various platforms, like LinkedIn, Instagram, Facebook, TikTok, and Twitter.
Current employees are every organization’s greatest asset. Encourage your internal team to promote job openings to their network by offering cash and other incentives.
We recommend these options when:
- Your brand has great name recognition
- You can consistently monitor and respond to candidate activity through your website and social media accounts
- You have a process in place to quickly and broadly communicate job openings and requirements
- You have an effective employee referral program in place
If you aren’t sure which path is best, schedule a discovery call today with our seasoned recruiting professionals. The 4 Corner team is on standby to help you find the best option for your unique hiring need.
Sample Interview Questions
- How do you verify insurance coverage and submit claims for reimbursement, and how do you ensure that they are submitted accurately and on time?
- What steps do you take to implement changes in insurance policies and regulations that may impact reimbursement procedures?
- In what way did you work with stakeholders to resolve a complex billing issue?
- Is there a reimbursement project you worked on that was successful, and what steps did you take to make sure that it was completed on time and within budget?
- How do you maintain accurate and complete records of all reimbursement activities, and how do you ensure their confidentiality?
- Do you have experience working with healthcare providers to ensure that their billing information is accurate and complete, and how do you address any discrepancies or errors?
- How do you manage rejected or unpaid claims?
- How do you ensure that you follow the correct reimbursement procedures for each type of insurance policy you work with?
- The Affordable Care Act and HIPAA are two examples of regulations and standards that must be followed by healthcare professionals. How do you ensure your work meets all of these standards and regulations?
- Are you able to resolve patients’ concerns or questions about their bills, and what steps do you take to make sure they are satisfied?
- Is there a time when you worked with insurance companies to resolve a billing issue, and how did you ensure that it was resolved quickly and accurately?