Patient Pay Rep – Reimbursement Specialist
Summary: The Reimbursement Specialist performs administrative and reimbursement functions at the regional billing office. This position oversees the accounts receivable functions including
qualification of appropriate documentation and billing. Ensures compliance with all government,
contract, and company policies and regulations. Identifies payment trends and helps to coordinate
collection activities. Identifies denial trends and corrects situation.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
Prepare and handle billing for accounts to ensure timely reimbursement
Identify insurance requirements including DMERC and Medicaid qualifications needed to ensure payer requirements are met
Verify balances and receipts of all cash payments
Research overdue accounts and follow up by mail and/or phone to insurance carriers or
customers on delinquent payments
Review claims denied for payment or underpaid claims
Resubmit claims with proper documentation for further carrier review
May coordinate collection activities for delinquent accounts by preparing information for collection agencies
Post payments and service dates to accounts to ensure accurate payment status and accurate account activity
Research unidentified payments using internal sources, written communication or phone inquiries to determine appropriate accounts to post payments
Respond to customer inquiries regarding account status in a timely manner
Research customer accounts thoroughly and documents appropriately
Resolve discrepancies and prepare adjustments and refunds as necessary
Audit incoming paperwork for completeness and accuracy to ensure proper documentation for billing purposes
Records batches received and documents errors
Brings recurring issues to the attention of management
Maintain accurate and current data files on all accounts
Qualifications: To perform this job successfully, an individual must be able to perform each
essential duty satisfactorily. The requirements listed below are representative of the knowledge,
skill, and/or ability required. Reasonable accommodations may be made to enable individuals
with disabilities to perform the essential functions.
Education/Experience: High school diploma or GED equivalency. Minimum of two years
reimbursement and/or insurance experience preferred. Infusion, Home Health, or DME
experience preferred. Strong interpersonal, communication, and organizational skills.
Computer Skills: To perform this job successfully, an individual should have knowledge of
Word Processing software.