Reimbursement Specialist II

The Spec II Reimbursement is responsible for collecting on all outstanding balances for a specific group of payors to ensure maximum reimbursement. This role involves more complex tasks including payor research, root cause analysis, and problem resolution resulting in increased revenue.

1. Responsible for collecting on all outstanding balances for a specific group of payors to assure maximum reimbursement.

2. Work aged accounts, process appeals and corrected claims, research and reconcile credit balance accounts, and process adjustments as needed.

3. Interact with payers and management team to ensure timely collections of accounts.

4. Demonstrate excellent performance by:

   1. Identifying and resolving AR related issues with sustained improvement in cash collections.

   2. Regularly demonstrating independent collection, problem identification, and resolution skills.

   3. Escalating and resolving issues with payor supervisors, managers, and provider relations.

   4. Participating in team meetings and collaborating with Reimbursement Specialists across the enterprise to replicate payor best practices.

5. Comply with applicable CLIA, HIPAA, and Compliance standards.

1. High school diploma or GED equivalent required.

2. 3+ years of experience working in medical billing or revenue cycle.

3. Proven track record of high performance.

4. Excellent organizational, communication, multitasking, and teamwork skills.

5. Regularly demonstrate independent collection problem identification and resolution skills.

6. Demonstrate ability to escalate and resolve issues with payor supervisors, managers, and provider relations.

7. Display exemplary teamwork, professionalism, and time management.

8. Ability to stay updated on industry trends, regulatory changes, and best practices in medical billing and reimbursement.

9. Proficiency in medical billing software and electronic health records (EHR) systems.

10. Working knowledge of ICD-10 and CPT codes.

Physical Requirements

Lifting Requirements -light work or exerting up to 20 pounds of force frequently. Physical Requirements -stationary positioning, moving, operating, ascending/descending, communicating, observing, pushing or pulling, and reaching. Use of equipment and tools necessary to perform essential job functions.

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