Job Title: Insurance Reimbursement Specialist
Department: Billing Reports To: Revenue Cycle Manager Location: Shelton, CT Terms: Full-time FLSA Status: Exempt
OPPOSITION SUMMARY
As an Insurance Reimbursement Specialist, you will work with insurance and billing companies to process medical reimbursements for patients. Your primary duties include claim review, appeal generation, interacting with patients, communicating with insurance providers, assist with retrieving EOBs, and other duties as assigned. To be successful in this role, you need strong analytical, communication, and organizational skills.
ESSENTIAL FUNCTIONS
Responsible for submission of appeals to national payers Provide review of all levels of an insurance appeal Gather supporting documentations (physician medical records, patient /physician letters etc.) Work incoming correspondence from payors to assist with claim appeal Interact with utilization review/management departments Assist with gathering EOB's if cash poster is unable to locate Provide excellent customer service via the handling of inbound and outbound calls/emails to patients and providers
Data Entry Assist with Error Processing when business volume dictates the need
PERFORMANCE MEASURES
Review claim denials within 1 week of posting to determine next step for accession Submit request to provider for necessary documentation for appeal- follow up on requests within 2 weeks if not received Submit accessions for adjustments per Patient Transparency Program guidelines and document accession to reflect need for adjustment accurately Follow up with plans when trends of nonpayment or incorrect payment is received per contracts Utilize portals/fax/USPS to submit appeals for claim review when necessary. USPS should be last resort if portal/Fax unavailable Provide payor status updates when issues arise to leadership Review Sfax for documentation relating to payor groups daily Review correspondence at the time of working denials to verify if we received essential information for the claim. Provide response to patient and client emails/voicemails within 24 business hours of receipt and document account appropriately
Adherence to schedule Productivity based on accuracy and quality Maintain a positive, achievement-oriented attitude and influence others to do the same Demonstrate high ethical standards and personal integrity Display a commitment to personal growth
MINIMUM QUALIFICATIONS
College degree preferred or equivalent but will substitute for applicable work experience Minimum two (2) years' experience in healthcare accounts receivable environment; knowledge of medical terminology, billing, and coding a plus Demonstrate proficiency in Microsoft Word and Excel Adhere to Medicare, Medicaid Compliance and HIPAA guidelines in relation to PHI information
KNOWLEDGE, SKILLS, AND ABILITIES
Exceptional analytical and organizational skills Ability to work independently, a team player with strong interpersonal skills to effectively interact with all levels of employees Superior time management and critical thinking skills Ability to work under pressure and achieve goals efficiently Strong written and verbal communication skills Dependable, flexible, and adaptable in all aspects of work
SUPERVISORY RESPONSIBILITIES
No direct supervisory responsibilities