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Reimbursement Specialist
2 months ago
BMR Partners Inc is seeking a highly skilled Reimbursement Specialist to join our team. As a key member of our revenue cycle team, you will be responsible for assisting in all areas of collection and billing.
Key Responsibilities- Claims and Billing: Follows payer requirements, policies, and procedures when billing for products, care, and services.
- Confidentiality: Maintains the confidentiality of patients/customers and their personal information.
- Timely and Accurate Claim Submission: Responsible for timely and accurate claim submission to all payers.
- Administrative Tasks: Performs billing, collection, scanning, filing, and audit functions as needed.
- Account Management: Ensures timely follow-up of assigned accounts and escalates issues to Supervisor/Director as needed.
- Communication: Notifies the appropriate person/department when missing data or documentation is not able to be obtained and is delaying the billing function.
- Account Receivable Management: Monitors account receivable balances in CPR+ and ensures AR is accurately notated and follow-up date scheduled.
- Customer Service: Answers phone lines in a timely manner, responding appropriately to questions and information received.
- Support Functions: Handles faxes as appropriate and as applicable. Backs up as needed for Patient Services.
- Quality Improvement: Participates in surveys conducted by authorized inspection agencies. Participates in the pharmacy's Performance Improvement program as requested by the Performance Improvement Coordinator.
- Committee Participation: Participates in pharmacy committees when requested.
- Professional Development: Participates in in-service education programs provided by the pharmacy.
- Compliance: Reports any misconduct, suspicious, or unethical activities to the Compliance Officer.
- Audit Response: Responds to payer pre and post payments audits timely. Works closely with Compliance to ensure proper information is sent.
- Additional Duties: Performs other duties as assigned by Supervisor.
- Experience: Minimum two years' experience in the Reimbursement field.
- Collection Experience: Minimum two years' experience in Collections, required.
- Knowledge and Skills: Knowledge of the terms and understanding associated with day-to-day functions of a reimbursement specialist.
- Multi-Tasking and Prioritization: Must be able to multi-task, prioritize, and be detail-oriented.
- Independence and Teamwork: Must be able to work independently and be willing to assist in other areas of the department as needed.
- Insurance and Billing Knowledge: Knowledge of insurance and specialized functions of billing and reimbursement, required.
- Communication Skills: Must possess excellent oral and written communication skills, with the ability to express technical issues in layman terms.
- Language Skills: Fluency in a second language is a plus.
- Customer Service and Problem-Solving: Must be friendly, professional, and cooperative with a good aptitude for customer service and problem-solving.
- Organizational Skills: Organizational skills sufficient to maintain consistently accurate records.
- Overtime: Open to possible overtime due to department demands.
- Education: High School Diploma or Graduation Equivalent Diploma (G.E.D)
- Experience: Prior experience in a pharmacy or home health company.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is continuously required to sit and talk or hear. The employee is occasionally required to stand; walk; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; and stoop, kneel, crouch, or crawl. The employee must regularly lift and/or move up to 20 pounds and occasionally lift/or move up to 30 pounds.
Specific vision abilities required by this job include close vision, peripheral vision, depth perception, and the ability to adjust focus.
