Account Reimbursement Specialist II
Job Summary: The Account Reimbursement Specialist II demonstrates a thorough understanding of medical office billing-related functions. This role will closely monitor and analyze payor denial trends, perform claim corrections, and perform timely claim follow-up by submitting appeals and claim reconsiderations to ensure maximum payor reimbursement. This role is vital to the overall financial success for the organization.
Primary Job Responsibilities:
- Ability to perform all responsibilities of ARS I position.
- Acts as point of contact for assigned department(s) for incoming questions regarding third-party billing requirements, denials, and patient-related billing inquiries.
- Coordinates with RCM team partners responsible for charge capture, coding, reimbursement and/or insurance verification to identify and resolve issues impacting billing and collections.
- Pursues timely collection of insurance claim payments using thorough follow-up efforts appropriate for each payor type (including denials, appeals, exceptions, exclusions).
- Review and interpret insurance explanation of benefits (EOBs) to ensure correct claim reconciliation.
- Filing appeals when appropriate to obtain maximum payor reimbursement.
- Analyzes trends in under/overpayments and payment denials and works collaboratively to develop process improvements meant to improve RCM operations and reduce costs.
- Coordinate medical records requests; process all insurance and patient correspondence to ensure compliance with all relative reporting and data collection regulations.
- Perform patient and insurance payor outreach to research and resolve payment-related inquiries for Athena patient cases.
- Work collaboratively with clinic managers and other RCM department staff to improve processes and procedures.
- Participate in department workgroups providing feedback and education on claims activities (payer denials, system issues, etc).
- Additional duties as assigned.
Requirements:
- Minimum of three (3) years of complex claim follow-up experience in a physician office, hospital, ambulatory surgery center or centralized medical business office.
- Knowledge of HMO/PPO, Medicare, Medicaid, and other payor regulations, payment guidelines, and policies.
- Knowledge of medical terminology, ICD-10, and CPT codes.
- Excellent verbal communication skills.
- Excellent computer skills; familiarity with Microsoft Word & Excel.
- Experience with AthenaHealth EMR is a plus.
- Ability to manage time and organize daily schedule to meet productivity and accuracy standards.
- Experience interpreting payor explanation of benefits.
- Excellent verbal communication skills and strong customer-service background.
Education and Certifications:
- Associate degree in business, healthcare administration or related field. Three (3) years of revenue cycle experience may be considered in lieu of degree.
Physical Requirements:
- Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
- Must be able to lift and support weight of 35 pounds.
- Ability to concentrate on details.
- Use of computer for long periods of time.
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