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REIMBURSEMENT SPECIALIST

1 month ago

Garden Grove, United States Kroger Full time
Job Description

Perform duties to process medical billing and PBM and medical collections with focus on accuracy, timeliness and adherence to process, to reduce denial rate, DSO, and bad debt. Recognize additional revenue opportunities, and improve in collection rates, while working within the limits of standard or accepted practice. Demonstrate the company s core values of respect, honesty, integrity, diversity, inclusion, and safety.

Responsibilities

- Review patient files for completeness and accuracy, identify and audit claims, ensure all revenue opportunities are included, and complete and submit billing, primary and secondary, to payers for reimbursement, via paper bills and clearing house submittals
- Review documents received including Explanations of Benefits (EOBs), Remittance Advices (RAs) and other documents indicating denials or claims acceptance
- Identify reasons for denials, take required corrective action, and take ownership of claims through to timely, successful collection
- Analyze denials, identify trends and recommend process improvement opportunities that will result in DSO reduction, superior collection rate and intervals, reduce bad debt, and simplified processes that are responsive to the requirements of specific payers
- Review claims with outstanding balances and identify actions to successfully collect revenues
- Follow up with insurers and patients to collect outstanding balances in an environment of world-class customer service focused on building enduring customer and business relationships; utilize Payer Portals via the internet for claim disposition
- Document case activity, communications and correspondence in computer system to ensure completeness and accuracy of account activity and actions taken to resolve outstanding claims issues; schedule follow-ups in required intervals
- Contribute medical billing expertise to the design of training and knowledge transfer programs, materials, policies and procedures to improve the efficiency and effectiveness of the Revenue Cycle Management team
- Assist with the processing online adjudication of collection issues and nurse billing as assigned
- Perform or assist with any operations, as required to maintain workflow and to meet schedules and quality requirements
- Participate in any variety of meetings and work groups to integrate activities, communicate issues, obtain approvals, resolve problems and maintain specified level of knowledge pertaining to new developments, requirements, and policies
- Perform other related duties as assigned
- Must be able to perform the essential job functions of this position with or without reasonable accommodation

Qualifications

Minimum
- High School Diploma or GED
- Any experience in medical billing or collections
- Superior communications skills; listening, speaking, understanding, and writing English while influencing patients, care givers, payer representatives and others, answering questions and advancing reimbursement and collection efforts
- Proven ability to identify gaps and problems from review of documentation, determine lasting solutions, make effective decisions, and take necessary corrective action
- Proven understanding of processes, systems and techniques to ensure successful billing and collection working with all payer types

Desired
- 2+ years of medical billing and/or collections experience
- Some jurisdictions may require the ability to be fluent in English and Spanish