Medical Reimbursement Advocate

Job Summary:

Reimbursement Advocate will work with Medicare, Medicaid, Commercial Insurance companies and customers to ensure medical claims are submitted timely, processed, and paid accurately. This includes working payor rejections and denials, obtaining qualifying documentation and authorizations, providing high level customer support, RUL’s, updating patient file within all billing systems as required, and following all applicable compliance and regulatory processes, payor guidelines, policies and procedures.

Responsibilities(Specific tasks, duties, essential functions of the job)

• Collect payments for outstanding open accounts receivable balances.
• Works with Medicare, Medicaid, Commercial Insurance, and Private Pay to ensure medical claims are being processed timely and paid accurately.
• Must meet/exceed daily/weekly production & quality KPI standards.
• Ensures all billing systems are updated timely with patient demographics, payer information, and notated appropriately.
• Analyzes payer claim rejections & denials to help determine root cause and prevention of future rejections & denials from reoccurring.
• Gathers, prepares, and submits required information and/or documentation to appeal claim denials.
• Uses appropriate write off reason code(s) for writing off balances that are deemed uncollectable.
• Responsible for assisting our patients, doctors, customers, and coworkers with billing inquiries at the highest-level support possible. This includes logging into phone queue and updating statuses appropriately.
• Ensures the billing of all claims via electronic or paper to Medicare, Medicaid, and Commercial Insurance payers are being submitted accurately and timely in accordance with policy.
• Ensures RUL(Reasonable Usable Lifetime) patients exiting the monthly cap period are in a billable status.
• Responsible for working NME’s (New Medicare Eligibility), Payor Changes, Pending Pick-ups, and Stop patients timely. Verifies and evaluates insurance benefits to determine the policy's compatibility with services.
• Ensures the timely procurement of all required documentation and obtain authorizations in order to prevent future denials.
• Ensures that appropriate medical records are maintained according to HIPPA guidelines.
• Ensures compliance with all state and federal regulations.
• Assists junior team members with general work-related issues and/or questions about departmental processes.
• Assist with monitoring team production & quality is meeting/exceeding KPI.
• Able to Identify process improvement opportunities and recommend potential solutions to improve departmental workflow.
• Responsible for reporting & analysis of daily/weekly/monthly reporting of department.
• Supports the B2B (Business to Business) rental program, to include billing, tracking units deployed & returned, and collecting past due payments.
• Maintain regular and punctual attendance.
• Comply with all company policies and procedures.
• Assist with any other duties as assigned.

Knowledge, Skills, and Abilities

• A comprehensive understanding of Medicare, Medicaid, and/or Commercial Insurance program rules as it pertains to DME billing.
• Ability to take direction and communicate effectively with customers and employees at all level of organization.
• Ability to thrive in a fast-paced and dynamically changing organization.
• Must have strong work ethic.
• Excellent oral and written communication skills required.
• Attention to detail is required.
• Effective conflict resolution.
• Ability to maintain confidentiality and exercise extreme discretion.
• Solutions-oriented problem solver.
• Excellent planning, communication and organizational skills.

Qualifications(Experience and Education)

• Operates at a task project level for select projects which are specifically assigned
• Some supervision required.
• High School diploma or equivalent, required.
• Some College and/or medical billing certificate, preferred
• 2 years of Medicare, Medicaid and/or Commercial Insurance experience, required.
• 2 years’ experience in oxygen or HME billing, preferred.
• Intermediate knowledge/proficiency in Microsoft Office, Oracle, Brightree, Salesforce and New Voice Media, highly preferred.
• A combination of training, education and experience that is equivalent to the qualifications listed above and that provides the required knowledge, skills, and abilities.