Job description

Join a thriving medical network as a Reimbursement Specialist ll!

The Reimbursement Specialist II is responsible for the complete revenue cycle including billing medical, dental and/or hospital claims. They are responsible for payer follow up and appealing of denied encounters to ensure accuracy of reimbursement.

This is not a remote position.

Apply now if you have:

• Certificate of completion of Billing and/or Coding
• 3 years’ experience in a medical billing department
• Knowledge of CPT, HCPCs, and ICD-10 coding as well as Medical Terminology

Essential Functions of the Job:

• Prepares accounts and encounters for accuracy for billing. Prepare, review, and transmit claims using automated systems and manual paper claim process.
• Provides any required attachments to third party claims including authorizations and EOB'S to ensure timely payment for the third party payer.
• Changes system financial settings once primary insurance has paid to insure that co-payments and deductibles are generated to guarantors.
• Identify and bill secondary payers.
• Ensures accurate calculation of disallowances and adjustments through analysis of contracts, Medicare and Medi-Cal reimbursement schedules and rates.
• Performs adjustment write off(s) keying and posting via computer input after obtaining approval signatures if required.
• Performs timely follow up on unpaid claims using the system work list and or Remittance Advices, EOBs, and other payment documents.
• Documents all analysis findings, phone calls and correspondence in the online practice management system.
• Respond to all patient or insurance telephone inquiries to ensure timely reimbursement.
• Must maintain assigned Accounts Receivable at or below goal on a consistent basis.
• Attends meeting and training classes as required by departmental or facility management.
• Will be called upon to perform special projects and participate in internal and external audits that may require some evening and weekend hours.
• Adheres to established departmental and facility policy and procedures, objectives, quality assurance programs, safety and infection control standards.
• Functions as a resource on assigned Accounts Receivable category to all staff and may assist with training.
• Attends training required by the State or Federal Government and Insurance plans to insure compliance to billing rules and regulations.
• Must be well versed and up to date in all billing rules and regulations to ensure compliance with federal and state laws.
• Must be able to track denials for the purpose of denials trending and management to report back to management.
• Ability read and interpret contract language is an essential function of the reimbursement specialist II.
• The reimbursement specialist II must be able to successfully prepare an appeal for a denial and receive accurate reimbursement

Job Type: Full-time

Pay: $19.00 - $26.00 per hour

Schedule:

• 8 hour shift
• Monday to Friday

Education:

• High school or equivalent (Required)

Experience:

• medical billing department: 3 years (Required)
• billing, CPT, ICD-10, and Medical terminology: 1 year (Required)

Work Location: In person

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