Job Description

• The Reimbursement Specialist is responsible for the accurate and efficient follow up and resolution of outstanding claims from insurance carriers, third party agencies and patients. The Reimbursement Specialist will coordinate, document, and communicate with health insurance representatives regarding proper insurance payments in accordance with policies and procedures, current federal, state and local and standards, guidelines, and regulations. The Reimbursement Specialist will assist the leadership on key reimbursement projects.
• This role will be hybrid - 2 days onsite and 3 days working from home.
• Medical Industry experience will be required.

• Responsible for accurate and timely collecting of billed and unpaid DME claims related to Commercial, Federal and State insurance plans and private pay accounts; monitor and minimize aged accounts receivables; ensure follow up on claims is within payer turn-around-time standards.
• Obtain and track claim status via phone and online portals.
• Monitor, take action, and respond to denials and claims related correspondence.
• Compose and follow up on claims appeals within specified payer timelines and protocols.
• Appropriately identify, address, submit or process adjustments, overpayments, and outstanding balances.
• Review and respond to payment information associated with Explanation of Benefits or Remittance Advice documents.
• Build relationships with insurance carriers and representatives.

• Updates claims related to change of insurance.
• Performs other duties as requested by supervisor or manager.
• Reviews and release rental agreement hold.
• Communicate and collaborate with the internal departments.
• Maintains strict confidentiality of patient personal information.
• Maintains HIPPA compliance.
• Understands business implications of decisions.
• Performs other duties as requested by supervisor or manager.

• Bachelor's degree or equivalent work experience or combination of secondary education and work experience in a healthcare related setting
• Four years of direct work experience related to medical claims billing/collections, insurance, appeals, authorizations
• Durable Medical Equipment (DME) claim processing experience preferred
• Demonstrated superior customer service skills
• Proven excellent verbal and written communication skills
• Strong computer skills, including word processing and spreadsheet software

• Reimbursement Specialist

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