What are the responsibilities and job description for the Reimbursement Specialist, RTB position at Pentec Health?
The Reimbursement Specialist, RTB is responsible for the resolution of unbilled tickets with the Ready to Bill file, under AUTH, INS, TERM, MGMT, etc. The role provides exceptional reimbursement expertise to provide support and resources for internal and external customers.
Essential Job Duties:
- Gather and document a detailed and comprehensive understanding of the various insurance plans and benefits for the different payor classes (State Medicaid, Commercial insurance and Medicare Part D plans) and being able to effectively communicate the therapy(s) and coverage requirements to the Payor sources.
- Apply prior and current knowledge of insurance carrier requirements and authorization practices to capture and communicate appropriate clinical and financial data required to obtain approval/authorization of services, professionally documenting a detailed outcome in CPR as needed.
- Serves as a resource and problem resolution expert for RCM and operates as a resource for Intake, patients, health care providers, clinical team, and payer relations personnel. Resolves complicated questions or issues relating to patient accounts and provides recommendations for identified deficiencies in current processes, system use or staff knowledge base
- Address challenges within the RTB, provide appropriate solutions, alternatives and follow up to ensure resolution of RTB tickets and authorization issues. Proactively works with RCM managers and supervisors to identify improvements needed to achieve company objectives and goals
- As needed, verifies insurance coverage and benefits through payor websites, E1 checks or by calling the payor directly. Enters information into CPR and communicates as appropriate to team members.
*Other job duties and special projects as assigned.
Ideal Candidate Will Have:
- Two or more years of experience in healthcare, medical billing, accounts receivable, reimbursement with focus on intake, insurance verification, authorization and billing and collections functions or Bachelors degree in Healthcare Administration or business-related field
- Excellent written and verbal communication and exceptional customer service skills; Demonstrate proactive problem-solving skills; Possess strong organizational and process skills.
- Familiarity with Joint Commission standards; Thorough understanding of HIPAA requirements; Ability to interact professionally with all levels of personnel within a company and independently manage tasks assigned, completing them within specified timeframes.
- Intermediate computer skills with programs such as Microsoft Office Suite: Outlook, Word, Excel and Power Point; Knowledgeable of CPR or other medical billing systems preferred.
Salary Range: $23 an hour
Pentec Health offers a comprehensive compensation and full benefits package. Actual pay will be based on several factors such as qualifications and skills for the role plus geographic location.
Benefits may include but are not limited to medical, dental, vision, 401k match, PTO, paid holidays, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
Salary : $23
