Reimbursement Specialist Job Description

Reimbursement Specialist Job Description

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Reimbursement specialist provides analysis and updates for CPT, HCPCS, CCI edits, Medicare Fee Schedule, commercial payer and Workers Comp coding changes.

Reimbursement Specialist Duties & Responsibilities

To write an effective reimbursement specialist job description, begin by listing detailed duties, responsibilities and expectations. We have included reimbursement specialist job description templates that you can modify and use.

Sample responsibilities for this position include:

Analyzes records to transcribe appropriate ICD-9, ICD-10, CPT, HCPCS codes
Monitors Medicare LCDs and updates relevant staff
Apply subject matter expertise to drive program offerings Education
Accurately interprets patient insurance, prescription and other health-related documentation
Communicates with insurance companies, patients, providers and prescribers to coordinate reimbursement and access solution
Handles high call volumes in a call-center environment
Advocates on behalf of the patient to problem-solve reimbursement and access issues
Works aged accounts, processes appeals or corrected claims, researches and reconciles credit balance accounts, and processes adjustments as needed
Interacts with patients, clinicians, insurers, Reimbursement Supervisor and Billing management to ensure timely collection of accounts
Creates and maintains accurate contract price schedules in computer system to facilitate accurate billing, correct accounts receivable and prompt payment

Reimbursement Specialist Qualifications

Qualifications for a job description may include education, certification, and experience.

Licensing or Certifications for Reimbursement Specialist

List any licenses or certifications required by the position: AHIMA, AAPC, CPC, CPR, CHONC, HCPCS, CPT, ICD, RHIT, CFR

Education for Reimbursement Specialist

Typically a job would require a certain level of education.

Employers hiring for the reimbursement specialist job most commonly would prefer for their future employee to have a relevant degree such as Bachelor's and Associate Degree in Education, Associates, Business, Medical, Medical Billing, General Education, Finance, Accounting, Healthcare, Health Care

Skills for Reimbursement Specialist

Desired skills for reimbursement specialist include:

Medical terminology
National Billing forms
Managed care
Reimbursement and regulatory compliance
Third-party payers
ICD-10
HCPCS
Public / private and federal funding mechanisms
Coding
Medicare

Desired experience for reimbursement specialist includes:

Data analysis and reporting Billing/Collections Insurance Claims Microsoft Office (Excel, Access, Word, Powerpoint) Good communication skills (verbal and written) are essential
Strong computer skills, including expertise in database management
Must have strong communications skills, including excellent interpersonal and relationship building skills, with the ability to present and communicate with healthcare professionals at all levels
Ability to be self-directed and autonomous
Must be proactive with lots of initiative
Must have ability to multitask and prioritize workloads

Reimbursement Specialist Examples

1

Reimbursement Specialist Job Description

Job Description Example
Our company is growing rapidly and is looking to fill the role of reimbursement specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for reimbursement specialist
  • Perform all duties necessary to maintain the accuracy of the charge master--coding and charging
  • Advise physicians and office staff on appropriate coding for procedures
  • Demonstrate proficiency in utilizing computer to access various software applications and resources essential to completing coding, edit, and denial processes efficiently, such as Epic (Resolute), payer reimbursement websites, and electronic medical record repositories
  • Ensure adherence to all applicable SOX coding/reimbursement controls, including, but not limited to Decentral Edit/Denial Processes and Review of Controllable Losses
  • Make forward progress within the training period toward meeting coding accuracy standards of the departments within the first year of employment
  • Monitor and resolve coding edits and denials in a timely manner to ensure optimal reimbursement while adhering to major payer regulations prohibiting unbundling, and resolve issues related to unlisted procedures or procedures with -22 modifier to ensure additional reimbursement
  • Partner with providers and coders to investigate payers' coding and reimbursement policies for new and/or existing services
  • Determines self pay pricing, communicates with patient or family and initiates confirmation letter
  • Works aged accounts 30-120 day, processes appeals or corrected claims, researches and reconciles credit balance accounts, and processes adjustments as needed
  • Ensure the accuracy of data from accessioning through claim submission
Qualifications for reimbursement specialist
  • One year of teller experience or a combination of teller and supervisory skills
  • Have a keen sense of attention to detail and accuracy
  • Must have strong analytical and problem solving skills with keen attention to detail
  • Must have strong understanding of confidentiality of patient records
  • Sales experience or experience in meeting/exceeding revenue goals a plus
  • Participate in conference calls with Client
2

Reimbursement Specialist Job Description

Job Description Example
Our innovative and growing company is hiring for a reimbursement specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for reimbursement specialist
  • Respond to inquiries from customers (physician’s office and/or patient) regarding bills or EOB’s received
  • Help to develop and implement Standard Operating Procedures with regard to billing processes
  • Collaborate with the Marketing team to develop and implement billing policies
  • Act as a liaison between our internal Finance team, Marketing, Sales, BSM/Accessioning and Clinical Services
  • Create, manage and resolve our month end recon process between our internal systems and that of our third party billing partner
  • Help patients and clients with various account issues
  • Create new customer accounts in coordination with Legal, Clinical Services and our third party billing partner
  • Ensures all cash is posted to the accounts receivable and balanced to cash received from the fiscal intermediary
  • Identify cash remittances by system categories and contact branches or organizations when needed to determine application
  • Receive daily deposit of insurance checks and forwards to appropriate parties for information
Qualifications for reimbursement specialist
  • Familiarity with telephony systems
  • Epic electronic medical record familiarity helpful
  • Experience in Home Health, Infusion Therapy and Respiratory therapy preferred
  • Achieving Results – Is goal directed and persistent
  • Computer proficiency in MS Office applications, with database experience a plus
  • Identify payer issues/trends and communicate payer updates to management as necessary
3

Reimbursement Specialist Job Description

Job Description Example
Our company is hiring for a reimbursement specialist. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for reimbursement specialist
  • Prepare notice of items that cannot be applied to a specific invoice
  • Balance and post cash the day it is received in accordance with established policies and procedures and ensures appropriate reimbursement
  • Prepare necessary adjusting entries for reimbursement variances ensuring appropriate records are maintained for cost reporting
  • Performs healthcare information & medical claims processing, healthcare billing & collection services, & provides financial guidance regarding hospital, HMO, clinical services to patients, their families & third-party representatives
  • Function as a liaison between special drug program patients & their insurance companies
  • Understand payer requirements for submission of patient claims including appeals
  • Populate and maintain SOPs, including payer specific data for the management of claims and communicate same to Customer Service
  • Monitor status of claims in collections system
  • Investigate error notifications and hand-off as appropriate
  • Respond to denials, re-submit and/or appeal as appropriate
Qualifications for reimbursement specialist
  • Research Payer requirements, pricing, and regulations that apply to our products
  • Insure compliance with all payer rules and requirements
  • Develop and maintain relationships with case managers and payer contacts
  • Experience with JD Edwards and ImageNow preferred
  • Two years accounting related experience generally required
  • Knowledge of heath care billing and collection procedures and microcomputer software/hardware
4

Reimbursement Specialist Job Description

Job Description Example
Our innovative and growing company is looking to fill the role of reimbursement specialist. Please review the list of responsibilities and qualifications. While this is our ideal list, we will consider candidates that do not necessarily have all of the qualifications, but have sufficient experience and talent.
Responsibilities for reimbursement specialist
  • Troubleshoot Medicare/private insurance denials
  • Work with Reimbursement, Professional Clinical Services, and Marketing to provide coding to customers that supports defined Reimbursement Strategies for existing, new and limited launch products within Orthotics & Prosthetics (O&P) and Mobility Solutions business units
  • Prepare complex claims reimbursement submissions in a managed care environment
  • Serve as an advocate and resource to clinic administration in the areas of reimbursement and managed care
  • Maintain and support relationships with customers and insurance/managed care organizations to ensure a successful reimbursement program
  • Monitor and report standardized metrics on claims status/progress in a timely manner
  • Establish contact points/relationships with payers to optimize claims/appeals process
  • Ensure completeness and accuracy of contract database for in-network payers
  • Monitor cash receipts against contracts database, follow up discrepancies as appropriate
  • When claim/appeals process exhausted (according to policy) hand-off to Customer Service to initiate collections from patients
Qualifications for reimbursement specialist
  • Must possess good leadership skills and have the ability to work independently
  • Must be analytical, flexible, innovation, and self-motivated
  • Charge Master experience a must
  • Microsoft Office - Excel proficiency a must
  • Previous experience working in corporate setting preferred
  • NextGen EHR experience preferred
5

Reimbursement Specialist Job Description

Job Description Example
Our company is looking for a reimbursement specialist. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for reimbursement specialist
  • Assist with the coordination of the case set up with wound care center/ providers, patients and sales representative
  • Demonstrate proficiency and full understanding of the Reimbursement Call Center Customer Relationship database including understanding of data elements, definition of various case statuses and outcomes, case documentation requirements and the importance of meeting program metrics
  • Handle all protected patient data according to strict HIPAA compliance and ethical record-keeping
  • Accurately document call details, follow up actions, and any other pertinent information within the Customer Relationship Management database
  • Identify and escalate customer concerns and program trends to the Reimbursement Services Manager Reimbursement Call Center team
  • Healthcare Information & Medical Claims Processing
  • Healthcare Billing & Collection Services
  • Providing financial guidance regarding hospital, HMO, clinical services to patients, their families & third-party representatives
  • Contacting insurance companies to verify eligibility coverage for drug benefits
  • Functioning as a liaison between special drug program patients & their insurance companies
Qualifications for reimbursement specialist
  • Health Insurance claims or patient accounting experience a plus
  • Experience with billing applications (ePremis, SSI)
  • Review accounts in Medipac to determine correct payment
  • Identify if underpayment or overpayment is due to incorrect contract information or if discrepancy is system related
  • Negotiate based on historical information for rate consistency
  • Two to five years billing and insurance follow-up experience preferred

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