Reimbursement Specialist Collector
4 weeks ago
Descripción del Puesto
El Especialista en Recaudación de Reembolsos es responsable de garantizar la recopilación de reembolsos de manera oportuna y precisa, manteniendo una comunicación efectiva con los pagadores, pacientes y cuidadores cuando sea necesario. Este rol también implica la capacitación cruzada con los miembros del equipo para proporcionar apoyo en funciones de facturación y pago adicional según sea necesario.
Funciones y Responsabilidades
- Administrar la recopilación de saldos pendientes tanto de compañías de seguros como de pacientes
- Realizar un seguimiento oportuno de todas las solicitudes de reembolso para garantizar una resolución rápida
- Revisar y corregir solicitudes rechazadas según sea necesario, asegurando una resubmisión precisa y oportuna para maximizar el reembolso
- Identificar, documentar y abordar errores de facturación, denegaciones y rechazos de solicitudes
- Analizar denegaciones y rechazos de solicitudes para identificar las causas raíces e implementar estrategias para prevenir futuras ocurrencias
- Colaborar con departamentos internos para abordar problemas sistémicos que conducen a denegaciones
- Apelar solicitudes denegadas y pagadas parcialmente para maximizar el reembolso
- Establecer y gestionar planes de pago para pacientes según sea necesario
- Iniciar contacto con clientes y compañías de seguros a través de teléfono o correo para facilitar pagos y resolver problemas de cuentas
- Monitorear y gestionar cuentas por cobrar
- Asistir en la preparación de documentación para auditorías y asegurar el cumplimiento con los requisitos regulatorios
- Mantener actualizado el conocimiento sobre políticas de seguros, regulaciones de facturación y estándares de cumplimiento
- Cumplir con la confidencialidad y adherirse a los estándares de HIPAA para el manejo de Información de Salud Protegida (PHI)
Requisitos y Calificaciones
- Atención al detalle, organización y habilidades de resolución de problemas, persistencia y flexibilidad
- Conocimiento de regulaciones de Medicare, Medicaid y seguros comerciales
- Habilidades en computadoras, incluyendo el uso de Excel, Outlook, preferible
- Exposición a HubSpot o otros CRM, preferible
- Excelente y efectiva comunicación
- Habilidad para manejar múltiples y cambiantes prioridades de manera efectiva
Formación y Experiencia
- Diploma de Escuela Secundaria o equivalente, requerido
- 1-3 años de experiencia en reembolsos médicos y DME, preferible
- Exposición a facturación y recopilación, preferible
- Experiencia en el uso de software de facturación médica como ADSC, preferible
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