Reimbursement Services Director directs and supervises the activities of the claims and provider reimbursement personnel. Handles third-party reimbursement for services rendered to patients. Being a Reimbursement Services Director sets procedures for filing reimbursement claims and ensures timely and accurate claims payments. Monitors, evaluates and reviews all cost reporting in support of reimbursement claims. Additionally, Reimbursement Services Director develops policies and procedures compliant with fiscal and regulatory requirements. Oversees the collection of statistical and financial data needed for preparing annual and monthly health insurance reports. May require an advanced degree. Typically reports to top management. The Reimbursement Services Director typically manages through subordinate managers and professionals in larger groups of moderate complexity. Provides input to strategic decisions that affect the functional area of responsibility. May give input into developing the budget. Capable of resolving escalated issues arising from operations and requiring coordination with other departments. To be a Reimbursement Services Director typically requires 3+ years of managerial experience. (Copyright 2024 Salary.com)
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.
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
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Work Location: In person
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