Reimbursement Specialist - Physician Billing

Location: Elmira, NY
Company: Arnot Ogden Medical Center
Industry: Healthcare
Job Type: Full Time
Posted: 5 days ago

MAIN FUNCTION:

The Reimbursement Specialist reports to the Reimbursement Manager of Revenue Cycle Services and is responsible for collaborating with the Manager for the Central Business Office (CBO).The Specialist obtains, reviews, and interprets payer information and enters the information into the practice management system. The Specialist reviews claims data, denials payer contracts, fee schedules and allowed amounts in collaboration with not only the Manager but also with the Director of Revenue Cycle to ensure the system logic and set up is consistent with the third party payer contract, credentialing, and fee schedules. The Specialist assists with all payer electronic data interchange enrollment, portal access, and follows-up with the payer(s) as assigned to manage electronic transactions and payer website access.

DUTIES AND RESPONSIBILITIES:

Reimbursement Process

  1. Identifies and investigates payer trends.

  2. Follows up with payers, vendors and clearinghouse to resolve unpaid or denied insurance claims.

  3. Verifies the appropriate use of modifiers, dependent on carrier requirements.

  4. Initiates and completes insurance/patient correspondence for claims resolutions.

  5. Properly updates account information (registration, insurance information, etc.)

  6. Researches credit balances and prepares refund requests where appropriate.

  7. Provides feedback and analysis of assigned accounts for review of client revenue.

  8. Answers both patient and carrier correspondence in a timely fashion.

Receivable Management:

  1. Reviews aged trial balance with outstanding charges and reworks as required to ensure payment.

  2. Initiates and completes carrier reviews.

  3. Receives phone calls from both patient and carriers which are to be handled in a professional and helpful manner.

  4. Maintains patient confidentially; complies with HIPAA and compliance guidelines established by Outpatient Services.

  5. Performs collection activities as assigned.

Other:

  1. Assists in development and maintenance of the Reimbursement process manual.

  2. Has ability to set and meet deadlines.

  3. Has ability to multitask.

  4. Has in-depth understanding of Medicare, Medicaid, and various public funding programs in order to effectively support the Revenue Cycle Department.

  5. Has ability to correctly discern problems following established procedures and determines appropriate course of action.

  6. Has ability to effectively handle multiple priorities within a changing environment.

  7. Other duties and projects as assigned.

  8. Is responsible for attending all annual mandatory educational programs as required by position.

  9. Employee understands and demonstrates the importance of satisfying the needs of the customer/patient by interacting with him/her in a friendly and caring way, being attentive to the customer's needs, both psychologically and physically, and by taking the initiative to maintain communication with the customer in order to provide a secure and pleasant experience with the Medical Center.

  10. It is understood that this job description lists typical duties for the classification and is not to be considered inclusive of all duties which may be assigned.

EDUCATION:

High school diploma or equivalent required.

EXPERIENCE:

2 - 3 years' experience in a healthcare setting working in the physician business office, revenue cycle department, or finance. Reimbursement experience with Medicare B, Medicaid and other third party payers. One to three years experience in billing. Demonstrated experience with billing for physician services. Data entry experience. Cash handling experience preferred. ICD-10, HCPCS and CPT experience preferred.

CARDIOPULMONARY RESUSCITATION (CPR) REQUIREMENTS:

No CPR required.

PHYSICAL DEMANDS:

Light physical effort, typical office job.

EXPOSURE CATEGORY:

Category III. Tasks that involve no exposure to blood, body fluid or tissues. And Category I tasks are not a condition of employment.