Commercial Reimbursement Specialist

A Growing leader in the Durable Medical Equipment industry with a focus on clinical respiratory equipment is seeking to add a Commercial Reimbursement specialist to our team.

This team member will be required to possess a vast knowledge of DME qualifications for equipment, Commercial Insurance experience and Brightree experience preferred. Candidate will review, analyze, and process denied insurance claims, appeals and reconsiderations as well as requests for medical records. Ability to contact doctor’s offices, patient’s and insurance companies requesting information needed by phone, faxes, and letters.

Key Responsibilities:

Commercial Insurance Denials:

• Review and analyze denied insurance claims.
• Research the reason for denial and determine if the claim is eligible for reconsideration or appeal.
• Prepare and submit appeals with necessary documentation and supporting evidence.
• Maintain detailed records of denial cases, actions taken, and outcomes.
• Stay updated on insurance company policies and procedures to ensure proper handling of denials.

Appeals and Reconsiderations:

• Write and submit detailed appeals for denied claims, including explanations of why the claim should be paid.
• Coordinate with the healthcare provider and insurance companies to resolve issues.
• Follow up on appeals to ensure they are processed within the designated timeframe.

Medical Records Requests:

• Handle requests for medical records.
• Coordinate with healthcare providers or facilities to obtain and submit the required medical records.
• Ensure all requests are compliant with HIPAA regulations and timely submitted.

Medicaid Secondary Claims:

• Assist in preparing and submitting secondary claims to Medicaid after primary insurance has been processed.
• Ensure proper coding and documentation to meet Medicaid requirements.
• Verify and follow up on any outstanding Medicaid claims to ensure timely payment.

Assisting with Incoming Calls:

• Answer and respond to calls from patients, providers, and insurance representatives.
• Provide assistance with claim status inquiries, billing questions, and other insurance-related matters.

The ideal candidate will be self-starter with strong communication skills, and organizational skills, multitask, a positive attitude and one who possesses a passion for customer service.

Job Type: Full-time

Pay: From $16.00 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: In person

Salary : $16