osition: Reimbursement Specialist
Schedule: Monday to Friday, 8 am - 4:30 pm

Job Responsibilities:

• Research and resolve rejections and denials.
• Document related account activities.
• Ensure timely follow-up with Medicare, Medi-Cal, Managed Medi-Cal, and/or commercial insurance payers (PPO and HMO).
• May be eligible for collection bonuses.

Experience Required:

• Minimum of three years of related experience.
• Previous experience in a medical office setting and/or with an Electronic Medical Record (EMR).
• Preferably experienced in Home Health Care or pharmacy Billing/Collections.

Knowledge and Skills:

• Understanding of medical terminology and insurance laws/guidelines.
• Familiarity with medical terminology.
• Knowledge of proper billing/CMS guidelines.
• Strong understanding of insurance eligibility (Medicare [A-D], government, and commercial).
• Good knowledge of ICD10 coding/HCPCS coding.
• Familiarity with pharmacy coding (NDC).
• Experience with Prior Authorization process (submission and appeals).
• Proficiency in MS Word, Excel, Outlook, and EMR.
• Strong analytical, organizational, and time management skills.
• Strong mathematical skills, including the ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.