What are the responsibilities and job description for the Reimbursement Specialist position at M Health Fairview?
Overview
Manage aging reports and oversee assigned accounts, including submitting medical records, appeals, audits and resolving claim issues. Maintain accurate billing and collections for home infusion claims, performing collection tasks and analyzing accounts for necessary documentation. Process third-party and patient remittances, ensuring precise payment applications. Proficiency in communication and technology is essential, as is the ability to adapt to daily changes and stay productive. Provide exceptional customer service to providers and patients in person and via phone.
Responsibilities/Job Description
Provide superior customer service, in person and on the phone, to all insurance companies, Fairview entities, and patients.
- Communicate effectively, both written and verbal
- Communicate appropriate information to others according to established procedures to support day-to-day operations
Process home infusion claims accurately and timely.
- Review accounts for all needed information and communicate to correct departments to add information needed to ensure proper billing.
- Screen claims on-line or on paper for accuracy
- Obtain appropriate information to process claims
- Communicate and request necessary information from payers, patients, Fairview Department
Interpret and demonstrate accurate application of third party payer and government payer contracts.
- Understand regulatory, HMO, PPO, Federal, State and other third party payer requirements needed to prepare and or process claims
Generate and monitor aging reports on third party payers
- Communicate denials and Eligibility of Benefits (EOB’s) to insurance company and patients
- Review aging reports that have reached certain aged categories (30,60,90 days,etc.)
- Maintain reports to 60 days
- Generate home infusion claims for resubmission for third party payer’s outstanding balances.
Prepare and request any credit or debit adjustments
- Research and refund patient or insurance company for overpayments
- Request adjustments on incorrectly processed claims
Qualifications
Education:
Minimum Education
- High School Diploma/GED
Preferred Education
- Vocational/Technical Training or Associate Degree or Certified Medical Billing
Experience:
Minimum Experience
- 1 year medical business office or pharmacy technician experience
- Six months customer service or data entry experience
Preferred Experience
- Three years medical billing or collection experience, Medicare, Medicaid, Third Party experience
Compensation
$20.01 - $28.25/Hr.
Salary : $20 - $28
