Reimbursement Specialist

We are seeking a detail-oriented and experienced Accounts Receivable Reimbursement Specialist to join our team. The primary responsibility of this role is to coordinate and maintain the professional reimbursement program, ensuring compliance with current payment, billing, and collection regulations. The Accounts Receivable Reimbursement Specialist will play a vital role in maximizing reimbursement of services by accurately using codes and staying up-to-date with reimbursement/payment rules and policy guidelines. Additionally, this role involves managing accounts receivable, reviewing claims, addressing customer inquiries, and collaborating with various stakeholders to ensure efficient revenue cycle management. The ideal candidate should possess strong analytical skills, a thorough understanding of medical billing processes, and a commitment to compliance with industry regulations. This is a temporary position that has the potential to transition into a long-term full-time role as we continue to grow.

Overall Responsibilities:

Assists in coordinating and maintaining the reimbursement program to ensure compliance with current payments, rules and legislative regulations that impact billing and collections. Monitors and evaluates current reimbursement/payment rules and policy guidelines to ensure that legislative and regulatory changes impacting medical billing are anticipated and communicated to the company. Ensures adherence to all HIPAA, JCAHO, and Compliance rules and regulations.

Reviews authorization, detailed prescriptions, and verification for claims within his/her work group, to ensure that accurate claims were submitted for revenue and their medical necessity in the event the services were not paid accurately.

Works towards minimizing AR within assigned workgroup by correcting and resubmitting claims, as well as submitting appeals. Communication with various insurance companies and payers to resolve billing and reimbursement discrepancies.

Reviews information provided by payers regarding the reimbursement for goods and services, usually on an Explanation of Benefits (EOB) or Remittance Advice, to ensure posting of payments align with these documents and reason for non-payment or inaccurate reimbursement. Trend identification should be performed through this process and escalated to management for global resolution.

Confirms and prioritizes pick-ups, exchanges, and returns on both serialized and non-serialized equipment and supplies to ensure inventory and other functional operating areas are not negatively affected.

Ensures that claims are followed up in a timely manner, specifically no longer than payer requirements, to avoid write-offs.

Requesting adjustments, write-offs, or refunds from manager on balances over $1,000.00.

Responds to customer inquiries both in person and telephonically as necessary, including but not limited to payments on account, questions about benefits, and questions about insurance policy.

Prepares and submits medical records to the various payers on request to facilitate payment for services or audit.

Meet or exceed Key Performance Indicators (KPIs) and productivity in all measured areas.

Performs other duties, as assigned by management.

Minimum of 2-3 years of experience in medical accounts receivable or related field, with a strong emphasis on accounts receivable and reimbursement.

Brightree experience required, DME experience preferred.

Thorough knowledge of reimbursement/payment rules, coding practices, and regulatory requirements.

Proficient in utilizing billing software systems and navigating various reports and portals.

Strong attention to detail and analytical skills to identify discrepancies and resolve billing issues.

Excellent communication and interpersonal skills for effective collaboration with internal and external stakeholders.

Ability to prioritize tasks, work independently, and meet deadlines.

Proficient in using Microsoft Office Suite and other relevant software.

Familiarity with HIPAA, HQAA, and Compliance rules and regulations.

High level of professionalism, integrity, and commitment to maintaining confidentiality.

---