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Reimbursement Specialist

2 months ago

Downers Grove, Illinois, United States ambercare Full time

About the Role

We are seeking a highly skilled Reimbursement Specialist to join our team at Ambercare. As a Reimbursement Specialist, you will play a critical role in ensuring timely and accurate reimbursement for our patients.

Key Responsibilities

  • Insurance Verification and Investigation
    • Accurately interpret patient insurance, prescription, and other health-related documentation
    • Conduct medical insurance verifications and investigations for commercial and government payors
  • Reimbursement and Access Coordination
    • Communicate with insurance companies, patients, providers, and prescribers to coordinate reimbursement and access solutions
  • Claims Management
    • Review unpaid accounts to determine status and take appropriate action to ensure payment
    • Review all claims for compliance and completeness for claims submissions
  • Alternative Funding Options
    • Research available alternative funding options to reduce patients' financial burden
  • Customer Service and Communication
    • Handle high call volumes
    • Communicate with internal and external departments to facilitate coordination of care
  • Regulatory Compliance
    • Maintain a high degree of confidentiality at all times due to access to sensitive information
    • Maintain regular, predictable, consistent attendance and be flexible to meet the needs of the department
    • Follow all Medicare, Medicaid, and HIPAA regulations and requirements
  • Additional Responsibilities
    • Perform other duties as assigned

Requirements and Competencies

  • Education and Experience
    • High school diploma or equivalent is required; undergraduate degree is preferred
    • Experience in medical billing, accounts receivables, and/or collections within a healthcare or insurance environment is preferred
  • Skills and Abilities
    • Possess quick and accurate Alpha/numeric data entry skills
    • Computer proficiency - MS Office and Web-enabled applications strongly preferred
    • Understanding of the requirements of Medicaid, Medicare, and Insurance billing is preferred
    • Maintain positive internal and external customer service relationships