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)
Responsibilities:
- Review and process medical billing claims
- Verify accuracy of patient demographic and insurance information
- Ensure compliance with coding and billing regulations
- Resolve billing discrepancies and denials
- Communicate with insurance companies and patients regarding billing inquiries
- Maintain up-to-date knowledge of medical coding systems, such as ICD-10
- Collaborate with medical staff to obtain necessary documentation for accurate coding
Requirements:
- Previous experience working in a medical office or healthcare setting
- Strong knowledge of medical terminology and coding systems
- Proficiency in medical collection processes
- Familiarity with electronic medical records systems
- Attention to detail and accuracy in data entry and record keeping
- Excellent communication skills, both written and verbal
- Ability to work independently and prioritize tasks effectively
Job Type: Full-time
Benefits:
Schedule:
Work setting:
Ability to Relocate:
Work Location: In person
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