Reimbursement Specialist Sample Job Descriptions

Reimbursement specialists are responsible for communicating and working with insurance companies and medical billing staff to manage billing and various reimbursements. This position requires an advanced understanding of records, coding, and billing practices to ensure compliance and patient confidentiality. If you want to be in a medical setting where you don’t have to be up and running, becoming a reimbursement specialist may be the right career for you. [Your Company Name] is searching for a compassionate reimbursement specialist that has a gift for working with others by listening and trying to fulfill their needs to their best abilities. If you have been in a previous insurance role and have strong organization skills, you may be the perfect candidate to fulfill our open position as a reimbursement specialist.

Typical duties and responsibilities

• Process claims quickly and accurately to ensure there are no errors
• Update patient medical files
• Investigate claims issues and make recommendations for process improvement
• Understand insurance carrier guidelines and stay abreast of any changes that occur to communicate them to management and staff
• Adhere to confidentiality, state, federal, and HIPPA laws and guidelines with regards to patient’s records

Education and experience

This position requires a high school diploma or GED.

Required skills and qualifications

• Understand medical terminology, accounts receivable, insurance collections, and billing
• Expertise in written and verbal communication
• Ability to think independently
• Excellent interpersonal skills
• Ability to recognize and deal with priorities

Preferred qualifications

• 2 years of experience in a call center/customer service-oriented role that requires attention to detail and basic computer skills
• General knowledge of benefits, healthcare, medical/pharmacy insurance is a huge plus

Responsible for the timely, accurate submission of invoices to the responsible payer, of any type, for all services and products provided. Evaluates payments received and applied to the patient account. Follows up with responsible parties to ensure the receipt of timely, accurate payments. Assists with Billing and Collection Training and completes “second-level” appeals to payers.

Job responsibilities

• Submits timely, accurate invoices to payer for products and services provided. Understands the terms and fee schedule for all contracts for which invoices are submitted. Correctly determines quantities and prices for drugs billed. Verifies that the services and products are correctly authorized and that required documentation is on file. Ensures that invoices are submitted for services and products that are properly ordered and confirmed as provided.
• Evaluates payments received for correctness and applies payments accurately to the system. Verifies that payments received are correct according to the fee schedule. Applies the payment correctly to the patient account. Ensures that secondary bills and patient invoices are mailed within 48 hours of receipt of payment. Notifies the Reimbursement Manager if there are overpayments and/or duplicate payments for the same service. Transfers payments belonging to other offices within 48 hours of receipt.
• Follows up on invoices submitted to ensure prompt and timely payment. Calls to verify that claims submitted were received and are in processing. Sends letters to the patient or responsible party when their insurance carrier fails to make payment reasonable time frame. Generates and mails statements and collections letters. Follows up on all denials within 48 hours of receipt.
• Ensures compliance with policies and guidelines outlined in the contract terms and fee schedule. Follows HIPPA guidelines when accessing and sharing patient information to maintain patient and business confidentiality.

Basic education and experience requirements

• High School Diploma or equivalent
• 0 – 6 months previous Infusion Reimbursement or Intake/Admissions experience

Basic qualifications

• Basic level skill in Microsoft Excel (for example: opening a workbook, inserting a row, selecting font style and size, formatting cells as currency, using copy, paste and save functions, aligning text, selecting cells, renaming a worksheet, inserting a column, selecting a chart style, inserting a worksheet, setting margins, selecting page orientation, using spell check, and/or printing worksheets).
• Basic level skill in Microsoft Word (for example: opening a document, cutting, pasting and aligning text, selecting font type and size, changing margins and column width, sorting, inserting bullets, pictures and dates, using find and replace, undo, spell check, track changes, review pane, and/or print functions).

How have you impacted someone’s life today? At ABC company our teams are focused on changing the lives of our patients by providing the highest level of care each and every day. From our hospitals, rehab centers, and occupational health teams to our long-term care centers and at-home care capabilities, our complete spectrum of services will allow you to apply your skills in multiple settings while building your career.

Responsibilities

• Assistance in the preparation of the Medicare and Chapter 160 cost reports by completing basic sections under supervision
• Quarterly coordination and accumulation of physician time studies
• Coordination and accumulation of statistical data
• Coordination and accumulation of Interns & Resident’s schedules and all required personal data
• Coordination and accumulation of all Direct Patient Care Contracted Labor & Administrative Contracted Labor
• Software input of the cost report data, as needed
• Performance of financial analysis of relevant reimbursement issues as they arise
• Preparation of the Hospice cost report with supervision
• Related sections of applicable monthly/yearly surveys. Other duties as assigned by Management

Qualifications

• Bachelor’s degree or equivalent experience in Finance, Accounting, and/or Economics with GPA above 3.0
• Possesses beginning to working knowledge of hospital reimbursement experience, including preparation of cost reports
• Demonstrated proficiency in Microsoft Excel and Word
• Effective written and verbal communication skills

Experience preferred

• One or more years hospital reimbursement experience, including preparation of cost reports

We are looking for an Insurance Reimbursement Specialist. The Insurance Reimbursement Specialist is responsible for collecting on all outstanding balances for a specific group of payers to assure maximum reimbursement.

Responsibilities

• Works aged accounts 30-120 days, processes appeals or corrected claims, researches and reconciles credit balance accounts, and processes adjustments as needed
• Interacts with patients, clinicians, insurers, Reimbursement Supervisor, and Billing management to ensure timely collection of accounts
• Participates in the Quality Assurance plan
• Complies with applicable CLIA and HIPAA regulations

Qualifications

• 3-5 years of experience working in medical billing, health insurance, or collections with demonstrated results
• Insurance billing experience is preferred
• High School diploma or GED required
• Good problem-solving and decision-making skills
• Time management skills are a must
• Excellent customer service and phone skills
• Excellent organizational, communication, multitasking, and teamwork skills
• Working knowledge of ICD-10, CPT, and HCPCS coding (preferred but not required)