Reimbursement Specialist - Healthcare determines the extent to which patients' insurance covers their treatments. Reviews appropriateness of CPT-4/ICD-10 coding and determines if care provided corresponds to the charges submitted. Being a Reimbursement Specialist - Healthcare ensures compliance with Federal and State regulations and company policies that govern Medicare and state payment systems. May assist in identifying fraudulent non-plan billing practices and assists the legal department with litigation preparation. Additionally, Reimbursement Specialist - Healthcare may require a bachelor's degree. Typically reports to a supervisor or manager. Typically requires Certified Professional Coder (CPC) from AAPC or AHIMA. The Reimbursement Specialist - Healthcare gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Reimbursement Specialist - Healthcare typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
Position Summary
The role of the Medical Reimbursement Specialist reports to the Director of Billing & Admissions, in partnership with the Dialysis CEO/Administrator. This position is responsible for for analyzing insurance documents, processing reimbursement claims, and releasing accurate billing statements for insurance claims. This position must possess excellent analytical skills, especially on performing clerical tasks to evaluate insurance cases, investigate cases, and update account information accordingly. This position must also possess consistent and effective communication skills and understanding of the insurance process in order to coordinate with the clients, explain procedures for claims accurately, and manage the insurance process for maintenance and improvement.
Essential Position Responsibilities
Qualifications
Work Environment: This position will spend 80% of time sitting while performing work in a standard office environment and 20% of time standing and/or walking while pushing, pulling, lifting, and/or carrying up to 50 lbs.