REIMBURSEMENT SPECIALIST

Job Role Summary

Medical billing and medical coding background is required for this role.  This position provides medical billing and coding services and is responsible for the submission of insurance claims to Medicaid and other third-party payors for reimbursement. The Reimbursement Specialist oversees the fee collection process and collects, monitors, and controls data relevant to the fee collection system and insurance billings.  This position follows up on and resolves unpaid medical claims and is also responsible for providing billing and coding support and training to clinic staff.  This position is 100% onsite/in-office with standard office hours of 8:00am to 5:00pm Monday through Friday.

Associated Job Duties

• Files claims electronically and on paper for reimbursement
• Posts payments electronically and manually to each individual patient account
• Follows up on unpaid claims, researching and resolving issues to secure payment
• Trains clinic personnel on billing software updates or new procedures
• Instructs staff on fee collection, patient eligibility and billing
• Develops and updates relevant forms, reports, patient encounter forms, etc. when changes occur to ICD-10 and CPT codes and new programs or projects
• Provides in-service orientations for fee collection system and required updates
• Maintains contact with clinic personnel to advise of current procedures and practices relevant to fee collection or insurance billing
• Cross-trained in all aspects of billing to assist in Dental, Immunization and Behavioral Health billing
• Stays current on insurance/carrier polices and billing updates
• Maintains provider status, updates and provider enrollment forms and applications, required for billing insurance, license and DEA numbers and applying for new provider status with insurance carriers

Associated Job Duties Cont'd

• Monitors patient charts for correct documentation of services rendered
• Conducts internal audits of charts to maintain accuracy of charting versing billing
• Compiles reimbursement reports
• Prepares monthly revenue reports of payments received, and amount billed
• Prepares other reports as requested
• Maintains up to date logs and files of documentation
• Develops and maintains alpha numeric files including patient encounter forms, monthly reports, special projects, insurance provider information, bulletins, etc.
• Updates Standard Operating Procedures/Desk Procedures
• Provides support and back up to Reimbursement clerk.
• Processes referrals for RBMC/Medicaid
• Assists Director of Finance and Medical Director on special projects
• Other Duties as assigned

Qualifications

• Demonstrated 3 to 5 years of related experience required
• Knowledge of ICD-10-CM, CPT and HCPCs codes required
• Specialized education/training normally acquired through up to 18 months 
• Medical Terminology
• Thorough knowledge of Medicaid and other third-party payor enrollment and billing requirements

Licenses/Certifications Required

• Certification in Coding and Billing preferred

Knowledge, Skills & Abilities

• Demonstrated 3 to 5 years of related experience
• Knowledge of ICD-10-CM, CPT and HCPCs codes and coding guidelines
• Specialized education/training normally acquired through up to 18 months 
• Medical Terminology
• Thorough knowledge of Medicaid and other third-party payor enrollment and billing requirements
• Strong interpersonal skills, written and verbal communication skills including ability to present results and interact with executive staff
• Professionalism and reliability along with the ability to stay focused and self-motivated while working independently with minimal supervision

Working Environment

• Standard office Equipment
• Standard office hours of 8:00am to 5:00pm, Monday through Friday
• 100% onsite/in-office
• Use of standard business software including Microsoft Outlook, Word, Excel, PowerPoint and Power BI
• Use of Medical billing/EMR software