The Insurance Reimbursement Specialist is responsible for the timely follow up and collection efforts on outstanding receivable accounts that are billed to insurance companies. Responsible for ensuring payment of claims from commercial insurers, managed care plans, and state and federal plans; this includes following up on zero pay claims (denials) as well as claims for which we have not received a payer response and issues that arise during the verification of insurance coverage. Responsible for the management and collection of insurance balances through the use of automated systems and revenue cycle processes. Ensures acceptable reimbursement and appropriate days in accounts receivables with timely account follow-up and resolution of outstanding charges owed by third party payers.
- Accurately decipher denial reason and prospectively plans follow-up steps utilizing the electronic billing system. Collection efforts for primary, secondary, or tertiary Insurances, which include calling commercial and government insurance companies
- Review managed care contracts to determine correct reimbursement for each account, Submit written appeals for underpayments to insurance companies. Tracks, recognize trends and analyzes ways to fix/reduce payer denials and rejections.
- Call insurance companies to check on the status of unpaid claims. Works on and tracks outgoing and incoming correspondence from insurance companies
- Understands and follows all federal, state, and local payer-billing requirements. Print and re-file claims as needed
- Answer incoming patient and insurance company phone calls as received. Work outstanding accounts receivable from work queues with proficiency and 95% accuracy
- Meets individual quality and quantity performance goals. Make independent decisions that require individual and/or team analysis, reasoning, and problem solving. Insurance denials research experience
- Knowledge and understanding of the healthcare revenue cycle. Knowledge and understanding of CPT4, ICD10 and HCPC coding
- Understanding and knowledge of insurance plans pertaining to contractual adjustments and discounts. Excellent customer service skills
- Ability to adhere to Neighborcare Health policy and procedures. Ability to be detail oriented and to problem-solving
- Ability to interpret and discuss an insurance explanation of benefits and payments. Ability to meet and comply with HIPAA/Confidentiality policies and procedures Ability to organize, problem solve, and work under pressure independently to meet critical deadlines
- Ability to demonstrate predictable, reliable and timely attendance. Knowledge of Managed Care, Medicare and Medicaid guidelines
- Skill in time management. Knowledge and understanding of policies and procedures governing credit balance analysis and resolution of provider contracts with insurance companies
Required: Revenue Cycle Specialist Certification ( AAHAM) after 6 months, High School diploma or equivalent required. 2-3 years of medical and/or dental A/R insurance follow up and denial research.
Preferred: Associates degree. 2-5 years administrative experience in a medical facility, health insurance verification, customer service, call center or related area.