Reimbursement Specialist

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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