Reimbursement Specialist

Performs moderately complex medical billing and account receivable follow up functions. Primary responsibilities include batch/submit claims to multiple insurance companies, post payments and track reimbursement. Enter EOB correspondence, payments, and denials in EHR system. Re-work rejections, conduct reconsiderations and appeals, submit medical records, and reconcile issues with insurance companies. Understand dual coverage plans to ensure accurate billing. Knowledgeable of medical claims standards, clearinghouse requirements and HIPPA.  Utilize various reports in EHR to monitor claims and accounts receivable to align with KPI’s. Communicates with peers, consumers and management regarding insurance or claims issues. Assist and/or serve as backup in any billing area and other duties as requested by supervisor. Works under moderate supervision with considerable latitude for the use of initiative and independent judgment.

Qualifications

Education, Training and Experience (including licensure and certification)

• Minimum High School diploma or General Education Degree (GED); 
• Two (2) years related experience and/or training, or equivalent combination of education and experience. 
• Knowledge of billing and coding requirements, insurance industry standards
• Knowledge of insurance benefits, primary and secondary billing requirements, etc. 
• Must be proficient with claims clearinghouse experience. 
• Preferences:  Minimum 3 years’ billing experience. CPB or CPC certification

Knowledge, Skills, and Abilities

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
• Proficient in billing guidelines, claims processing standards, and denials management.
• Must have good communication skills, well organized, a self-starter and ability to complete assigned duties in a timely manner. 
• Knowledge of MS Word, Excel, medical practice management systems and computer operational skills.
• Must have a valid Texas driver’s license.