The Medical Reimbursement Specialist position focuses on the accurate and timely resolution of both insurance and patient claims. This includes, but is not limited to revenue collection, denials and appeal filings. Communicating with insurance BCBS carriers, including local and out of state plans, physicians, patients and management to achieve resolution of issues and expedite claims payment is vital in this position.
- Responsible for the proper and timely processing of multi-specialty claims and payments from state/third-party, payers.
- Proven ability to identify and analyze claim issues. Continued monitoring and review of open Accounts Receivables, adjustments, refunds, and changes.
- Prepare claim reports for administration and finance on utilization and claim payment turnaround time. Prioritize collection activity to avoid write-off exposure.
- Gather data on daily, monthly and yearly basis to determine status of insurance accounts.
- Submission of complete and detailed appeals; provide assertive follows up.
- Promptly respond to denial letters and requests for information.
- Maintain clear and cohesive notes/documentations/forms related to all open and pending claims being worked.
- Knowledge of medical terminology, CPT and ICD Coding and billing forms (HCFA).
- Excellent verbal and written communication skills.
- Excellent organizational and business office skills.
- Ability to build and maintain strong relationships with insurance representatives.
- Ability to work effectively with physicians and other medical staff.
- Maintain patient and company confidentiality.
- Other responsibilities as assigned.
- High School Diploma or equivalent, Associates Degree or equivalent in related experience.
- 5 years’ experience in billing and collections with out of network for a Pain Medicine/Chiropractic/Rehabilitation environment a MUST.
- Strong working knowledge of Out of Network providers with BCBS.
- Must be goal and detail-oriented and able to perform successfully in a fast-paced medical environment.
- AllScripts PM experience a PLUS.
Compensation & Benefits:
- $35,000 – $45,000 salary based on experience
- Health, dental and vision benefits available
- 401K with company match
- AFLAC insurance available
- Paid PTO