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Reimbursement Specialist

Posted: September 19, 2024
Salary:US$46350.00 - US$48000.00 per year
Location:Friendswood
Job type: Permanent
Discipline:Life Sciences
Reference:119425_1726760464
Work Location:On-site

Job description

Job Description

  • Answer incoming calls from patients, clinician offices, and area sales managers to answer billing-related questions. Educate callers on our reimbursement process, billing policy, and the need for required documentation for appeals and ease any concerns.
  • Request relevant medical records from clinician offices and ensure appropriate documentation is received and conduct follow-up with the office when applicable.
  • Review medical records for key details and create custom medical records and appeal cover letters.
  • Make outbound calls to patients regarding patient consent appeal requirements and effectively communicate the reimbursement process.
  • Review insurance denials, and insurance company medical policies and submit custom appeal letters.
  • Review and resolve front-end claim issues for timely and accurate claim submission.
  • Place outgoing calls or emails to patients, physician offices, and sales for required information.
  • Review EOBs and electronic remittance advice, and denial letters, assign appropriate ANSI codes, and take the necessary action in the billing system.
  • Place calls to insurance companies to obtain missing information and/or determine the status of submitted claims as needed.
  • Utilize payer portals or place follow-up calls to payers for claim status.
  • Posting insurance, client, and patient payments and taking the necessary action in the billing system
  • Provide additional documentation to payers when requested to fully adjudicate claims.
  • Review and submit medical records and appeals to provide proof of medical necessity/criteria to payers.
  • Investigate, evaluate, and report payer trends to identify opportunities for process improvement.
  • Responsible for working various billing-related work queues in the billing system.
  • Identify and report changes to insurance company processing requirements.



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