What are the responsibilities and job description for the Reimbursement Specialist position at Metrolina Nephrology Associates?
Description
Metrolina has competitive wages and benefits and a generous paid time off package beginning in your first year of employment: 4 weeks (accrued) paid time off PLUS 7 additional paid holidays! We also have a generous 401k plan with company match beginning after 90 days of employment with two entry dates (Jan & July). We offer two medical plans, company paid employee dental, vision, basic life insurance, voluntary life insurance, disability, critical illness, accident and pet insurance among other great benefits.
Metrolina Nephrology Associates is the region’s most recognized and experienced nephrology group. The practice has been on the forefront of the treatment and management of kidney disease for more than 40 years. Composed of 40 Nephrologists and 40 Nephrology Advanced Practitioners, our practice serves patients from eight convenient locations. Our extensive network of providers and offices allow our practice to deliver care in an atmosphere that is personal, patient centered, and compassionate.
It is our mission to provide the most comprehensive nephrology services available with a personal commitment to enhance our patients’ quality of life through professional activity and dedication.
By providing service excellence through highly specialized physicians and staff, we commit to serving the individual needs and circumstances of patients.
A non-exempt position responsible for claims follow up and collections on accounts. Responsible for overseeing metrics by payer to include but not limited to work Navicure rejections, claims follow up and denial follow up.
- Researches and reviewed unpaid claims
- Understands how to bill a claim to Navicure as well as correct front end edits on Navicure
- Submits all payer refunds to management for review
- Understands voids and re-enters
- Requests coding changes
- Understands the contracted timely filing limits for claims based on carrier plan for all payers that CEMM contracts.
- Informs billing office staff of changes based on payer information received.
- Investigates patient eligibility and corrects as needed in the practice system
- Bills all insurance claims and statements
- Works insurance assigned AR
- Works payer denials
- Works Navicure edits and rejections
- Refiles accounts that may not have crossed over to the clearinghouse (Navicure)
- Answers patient billing calls and provides a status to the patients within 24 hours
- Researches account to provide the best possible outcome for the patient and CEMM.
- Works with insurance companies to provide missing documentation to ensure payment of claims.
- Maintains excellent rapport with insurance companies and representatives to assist with claims processing
Requirements
Attendance: Regular, reliable, and punctual attendance is an essential function of this position. The ability to consistently adhere to scheduled work hours and fulfill job responsibilities in a timely manner is critical to the success of the role and the overall operations of the team.
- Understands how to read and interpret explanation of benefits, provides excellent customer service, accounts receivable follow up, obtains insurance authorizations, appeals denied claims.
- Past work with a claims clearinghouse is a plus. Medical billing certificates a plus, 2-3 years of insurance reimbursement experience a plus, experience with claim rejection and denials a plus.
- Must have a high school diploma or equivalent, have a basic understanding of medical terminology and insurance billing, 5 years’ experience in a business office setting.
- Knowledge of Allscripts, Navicure.
- Understands how to interpret 835's and explanations of benefits.
- Accounts Receivable follow up, obtaining authorizations, appealing denied claims
