Reimbursement Specialist Collector

4 weeks ago


Princeton, New Jersey, United States Lingraphica Full time

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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