Reimbursement Specialist

Job Summary

Small privately-owned home medical equipment company looking for an experienced reimbursement specialist. Candidate must have excellent telephone skills, be highly organized and can work in a fast-paced small business environment. This position is directly involved with claim processing, appeals, verification of eligibility and benefits. This role works in tandem with others in the organization to facilitate communication regarding out of pocket expense for equipment prior to scheduling.

Responsibilities and Duties

Serve as a reimbursement resource for internal office administration and external customers(customers, payors, physicians, sales team)

Verifies coverage and benefits for new patient referrals

Reviews the patient’s medical records to obtain primary and secondary insurance payor information, and relays this to the intake department.

Manage and track all claim submissions status with payers.

• Proactively follow up on claim status, re-billing, precertification’s , and appeals.
• Review Explanation of Payments and take appropriate action via verbal or written appeal to challenge short/zero paid claims and various denials.
• Ensures claims are paid according to contractual agreements.
• Demonstrate proven knowledge and technical skills to perform insurance follow-up with positive financial results to include accuracy, timeliness, and attention to detail.
• Answer incoming calls and electronic mail regarding insurance inquiries
• Process patients billings and AR to keep customers accounts’ current.
• Maintain high level of integrity and confidentiality / patient privacy (HIPAA). All information (written, verbal, electronic, etc.) that an employee encounters while working in a reimbursement environment is always confidential.
• Serve as a reimbursement resource for internal office administration and external customers(customers, payors, physicians, sales team)
• Generate monthly reports as required by department or payor contract
• Deliver superior frontline customer service to the satisfaction of End Users and Health Care Professionals to ensure positive outcomes and impact on future sales.
• Remain current on third-party coverage, reimbursement information, trends, ICD-9, ICD-10, and HCPCS
• Monitor payer policy activities on technology coverage and payment.
• Assume and perform other duties as assigned.

Qualifications and Skills

2 years of billing experience with medical billing and/or insurance collections preferred. Proven knowledge of and experience with ICD-9, HCPCS, and modifier coding. Outstanding interpersonal, verbal, and written communications skills required. Must be flexible and able to work in a fast-paced, heavy volume work environment. Demonstrated computer, prioritization, and time management skills. Experience working at insurance companies/payors or with medical device reimbursement for a start-up or new technology company or durable medical equipment setting is high desirable.

EDUCATION/KNOWLEDGE

High school diploma or general education degree GED. Familiarity with medical device reimbursement from a manufacturer or DME perspective is preferred.

EXPERIENCE

Minimum one- year of billing experience with medical billing and/or insurance collections preferred. Proven knowledge of and experience with ICD-9, ICD-10,HCPCS, and modifier coding. Outstanding interpersonal, verbal, and written communications skills required. Must be flexible and able to work in a fast-paced, heavy volume work environment. Demonstrated computer, prioritization, and time management skills. Experience working at insurance companies/payors or with medical device reimbursement for a start-up or new technology company or durable medical equipment setting is high desirable

SKILLS

Effective written and verbal communication skills. Planning, documentation and organization skills. Able to independently problem-solve; effective multi-tasking ability; attention to detail; excellent computer and telephone skills; time management skills - ability to prioritize, ability to work in a demanding, fast-paced environment; high level of energy, motivation and flexibility. Flexibility in a start-up environment to work outside of set job responsibilities

LANGUAGE SKILLS

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write, read, and interpret routine reports and correspondence, frequently medical in nature. Ability to speak effectively over the phone and before groups of customers or employees of the organization.

MATHEMATICAL SKILLS

Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.

Benefits

PTO, Paid Holidays, Health insurance, Dental insurance, 401k, 401k Employer Match.

Job Type: Full-time

Pay: $43,256.00 - $47,318.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off

Schedule:

• 8 hour shift
• Monday to Friday

Education:

• Associate (Required)

Experience:

• Medical collection: 2 years (Required)
• Medical billing: 1 year (Preferred)

Shift availability:

• Day Shift (Preferred)

Work Location: In person