Reimbursement Specialist III Three Oaks Hospice Inc Three Oaks Hospice Inc

Position Summary: Responsible for the billing and collections for assigned hospice agencies within the company. Additionally, this position will be instrumental in analyzing and following up on billed medical claims to determine the appropriate course of action to resolve the claims in accordance with state and federal guidelines.

Essential Duties:

  • Follow up on Commercial, Medicare, Medicare Advantage Plans, and Medicaid claims by phone calls to the insurance companies, checking websites, or online resources. Phone calls to the patient may be necessary as well.
  • Ensures all documents are in order and submitted timely in accordance with state and federal standards.
  • Filing appeals on denied claims when appropriate.
  • Posting payments from all payor types.
  • Assist in the preparation of billing and collecting activity reports.
  • Monitors the completion of all appropriate billing documentation on a regular basis.
  • Obtain benefit verification and authorization for insurance benefits.
  • Identify trends consistently and communicate findings effectively for quick resolution.
  • Always maintains high standard of compliance in ethical and federal regulations.
  • Performs other duties as required.


Qualifications:

  • High school diploma or equivalent is required; Undergraduate degree is preferred
  • Five years of Hospice billing experience; Medicaid Room and Board experience required
  • Understanding and knowledge of requirements of Medicare, Medicaid and Commercial billing
  • Ability to read and understand claims to effectively review and process billing requirements
  • Ability to exercise discretion and independent judgment
  • Excellent oral and written communication skills
  • Ability to work with high volume of work while maintaining attention to detail
  • Computer proficiency in MS Office and Web enabled applications

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