Claims Reimbursement Specialist

4 days ago


San Bernardino, California, United States TEKsystems Full time
Job Summary

We are seeking a highly skilled Claims Reimbursement Specialist to join our team at TEKsystems. As a Claims Reimbursement Specialist, you will be responsible for systematically analyzing and auditing claims for overpayments and applying billing rules to determine the appropriate party to refund.

Key Responsibilities
  • Analyze and audit claims for overpayments and apply billing rules to determine the appropriate party to refund.
  • Research and analyze the status of insurance refunds and communicate professionally with insurance companies regarding the status of requests, paid/pending claims, and the rebilling of unpaid claims.
  • Determine and submit appropriate documentation for refund approvals and follow guidelines as outlined in FPBO policies and procedures or instructions provided.
  • Ensure that registration data is accurate and updated, utilizing all available data resources as determined by FPBO and transfer any claims that require charge corrections to the assigned party.
  • Provide on-line documentation per account and perform proactive follow-up using Tickler List.
  • Through careful research and interpretation, determine the financial responsibility of refund balance.
  • Work rejected refund requests on a daily basis.
Requirements
  • Strong analytical and problem-solving skills.
  • Excellent communication and interpersonal skills.
  • Ability to work in a fast-paced environment and meet deadlines.
  • Knowledge of healthcare reimbursement and billing rules.
  • Experience with claims processing and reimbursement systems.


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