Reimbursement Specialist

Job Description

Job Description

Connexion’s mission is to provide "best in class" services to job seekers. We strive to achieve excellence in job placement, staffing, and recruiting services, while treating candidates with the professionalism and respect they deserve.

Job Title: Reimbursement Specialist
Shift: M-F between 8am-5:30pm
Notes:

• The job description is below, but it is meant to encompass all aspects of the RCM department.
• Specifically, we are looking for candidates with a deep background in medical billing and denials.
• Experience in DME would be a big plus but not necessarily required.

Principal Function:
To service patients through the completion of clearance work prior to an order shipping including but not necessarily limited to verifying insurance benefits and obtaining required documentation. To continue to provide service to patients post shipment by billing claims, reconciling remittances, responding to audits, working denials, and collecting payments.
Supervisory Responsibilities:

• None

Essential Duties:
(Includes the following. Other duties may be assigned)
Job duties and responsibilities are all-inclusive of the Reimbursement departments (i.e. document management, insurance verification, claims, accounts receivable, audits, denials, refunds, posting, and returns). Incumbents are expected to perform the duties specific to the area. They are assigned to:

• Gathers, scans, validates, and logs various document types.
• Completes insurance re-verification process via online tools and phone calls.
• Place outbound telephone calls in response to the customer’s inquiry as documented on the service ticket, correspondence, statement or denial assigned.
• Responds to all audit requests in a timely and meticulous manner.
• Works all types of denials.
• Perform front end edits to claims to ensure accurate submission.
• Works claim rejections for resubmission.
• Obtain payment in full on balances due and/or establishing payment plans where applicable.
• Timely completion of aging reports, service ticket and denials in accordance with the goals and procedures established by the leadership team.
• Receive inbound or place outbound calls in response to outstanding past due balances as they relate to the individual payer sources.
• Research and problem resolution, communicating the outcome to the customer as appropriate.
• Reconciles payer remittances and posts payments/adjustments appropriately.
• Post all adjustment entries to the correct General Ledger account.
• Processes and generates refunds as needed.
• Additional duties required as directed by Management.

Behavioral Standards:

• Available and flexible in scheduling to meet the changing business requirements of the position.
• Responsible for following good housekeeping and quality procedures.
• Follows and observes all safety practices.
• Establish and maintain effective working relationships with customers and/or co-workers.
• Establish and maintain effective knowledge of policies, procedures, and skills required to complete job duties.
• Exceeds quality and quantity performance standards by meeting daily production requirements as assigned by management
• Supportive in assisting the leadership team in achieving departmental goals by completion of special assignments, training, etc.
• Sets a positive example for co-workers by observing and adhering to all departmental and corporate policies and/or procedures.

Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required.
General Requirements:

• Demonstrate strong understanding of Medicare and Corporate Compliance Guidelines.
• Ability to process claims electronically via computer application systems.
• Able to utilize all company and Medicare guidelines when entering all information and documentation into multiple computer programs with the utmost of accuracy.
• Expertise with regard to the Cash Application process and the effects of credit/debit transactions.
• Analytical skills required to dissect accounts and resolve past billing issues.
• General understanding of how credits/debits impact accounts receivable.

Education/Experience:

• High school diploma or general education degree (GED); and one to two years’ experience in any of the following areas: insurance verification, medical billing, collections, customer service, accounts payable or call center operations field, accounts payable, bookkeeping, cash posting and data entry; or an equivalent combination of education and experience.

Computer Skills
Required:

• Knowledge of basic computer skills, PC Literate in windows-based software, capable of transitioning/navigation between multiple systems to process data.
• Requires the use of a keyboard while on the phone to document the results of phone conversations.

Preferred:

• Experience with Microsoft Office

Language Skills:

• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
• Ability to write routine reports and correspondence.
• Ability to speak effectively before groups of customers or employees of organization.

Mathematical Skills:

• Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages, area, circumference, and volume.
• Ability to apply concepts of basic algebra and geometry.

Reasoning/Ability:

• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form.
• Ability to deal with problems, involving several concrete variables, in standardized situations.

Attitude:

• Must have a cooperative attitude.
• Ability to relate to and accommodate various personalities and knowledge base levels.
• Must be a team player and mentoring in spirit and attitude.
• Ability to communicate with a positive and progressive attitude.
• Always possess a professional presence and demeanor.

Physical Requirements:

• Able to sit for extended periods of time.
• Able to use keyboard and mouse while completing assigned tasks.
• Bend and reach with hands and arms occasionally.
• Able to lift and carry up to 25 pounds occasionally.

Work Environment:

• The noise level is typical moderate noise (examples: Business office with computers, printer, and light traffic).

Company DescriptionConnexion Systems & Engineering is a full-service staffing firm, whose mission is to provide "best in class" staffing services to our clients and job seekers alike. We strive to achieve excellence in staffing, job placement and recruiting services, while treating our clients, employees, and candidates with the professionalism and respect they deserve.

Company Description

Connexion Systems & Engineering is a full-service staffing firm, whose mission is to provide "best in class" staffing services to our clients and job seekers alike. We strive to achieve excellence in staffing, job placement and recruiting services, while treating our clients, employees, and candidates with the professionalism and respect they deserve.