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Reimbursement Specialist

The Reimbursement Specialist (RS) will review and resolve overpayment on Insurance accounts and when required patient accounts. In addition, based on business requirements, the (RS) will be expected to work medical records when needed and perform other duties within the department as assigned by Refunds Section Supervisor (RSS).

Work Hours:

The normal work-week is 35-40 hours/week full-time, Monday through Friday as scheduled, or 15-34 hours/week for part-time position as scheduled. Occasional overtime or variations (including evenings and Saturdays) may be required or authorized.

Education & Training:

  • Must have High School diploma or GED
  • Must have one of the following:
    • 2 years related experience
    • Certification from vocational school plus 1 year related work experience

Driver and Reimbursement Requirements:

A valid state driver’s license, personal vehicle, vehicle insurance and a good driving record are required. Position requires travel and is authorized for mileage reimbursement.

Essential Knowledge, Skills & Abilities:

  • Must possess good customer service skills
  • Must possess effective reasoning and deductive ability
  • Must be able to work in team environment, as well as independently
  • Must be able to communicate effectively in English (grammar, spelling, writing, and verbal skills)
  • Must be able to read, correctly interpret and follow written guidelines/protocols
  • Must be able to learn and apply new skills
  • Must be able to prioritize multiple tasks to work efficiently
  • Must be organized, detail oriented and able to adapt quickly to stressful work environment
  • Must have the ability to self-check to minimize errors
  • Must have the ability to use personal initiative for self-direction of work projects
  • Must have understanding of accounting and billing policies and procedures
  • Must consistently exhibit mature and tactful attitude
  • Must maintain absolute confidentiality when dealing with financial and medical information
  • Accurate use of the 10-key adding machine by touch required
  • Medical and Accounting software experience preferred
  • Ability to communicate in Spanish helpful
  • Medical office experience required

Essential Job Functions & Duties:

OVERPAYMENTS
  1. Researches and prepares recommendations for reimbursement or adjustment to overpaid accounts
  2. Records reimbursement and adjustments
  3. Researches and records pending recoupment transactions
  4. Documents support for pending recoupment transactions
  5. Reviews, researches and prepares recommendations on reimbursement requests received from employers, carriers and patients
  6. When necessary, contacts employers, carriers or patients to resolve overpayment issues
  7. Identifies and conveys payments to related accounts
  8. Reviews and records internal refund tasks from clinics pertaining to patient credits
  9. Reviews and records transactions to adjust incorrect allowable amounts
  10. Reviews documentation and records reversal of credit card chargebacks and records patient refund to be paid by check
  11. Generates refund reports for review
  12. Refunds and moves money in various medical software
  13. Assists in training Reimbursement Representative (RR) to perform assigned tasks as directed by the RSS
MEDICAL RECORDS REQUESTS FROM EXTERNAL SOURCES (7 DAY RESPONSE TARGET) As Needed
  1. Logs new medical record requests daily and updates existing request still pending as needed
  2. Verifies authorization to release records
  3. Identifies type of records being requested
  4. Retrieves and copies records from off-site storage facility
  5. Creates and faxes invoices for medical records services
  6. Processes Subpoenas, Depositions and Affidavits as requested
  7. Faxes, Mails and Saves to Disk requested records (if payment is required, hold records until payment is received)
  8. Testifies in court to present medical records into evidence as required by law
  9. Maintains paper or electronic documentation of records provided
  10. Maintains knowledge of current laws (HIPPA and others) that govern release of medical records through continuing education
  11. Maintains storage files and x-rays
OTHER
  1. Interacts with staff members professionally
  2. Follows company policies and procedures (time and attendance, appropriate attire, etc)
  3. Correctly uses office equipment
  4. Works safely
  5. Other duties as assigned
  6. Must be punctual and reliable in attendance

Customer Service Skills:

  1. Answers questions from internal and external customers in a professional manner
  2. Responds to requests from internal and external customers in a professional manner
  3. Meets the service expectations of patients
  4. Resolves problems identified by patients
  5. Meets the service expectations of internal customers
  6. Resolves problems identified by internal customers
  7. Meets the service expectations by external customers
  8. Resolves problems identified by external customers
  9. Follows through on commitments
  10. Interacts with co-workers in other departments in a manner that promotes teamwork and facilitates company goals

Working Conditions & Risks:

Work is normally indoors in a well-lighted and seasonally heated and cooled business office. Job hazards are estimated to be minimal (low risk). Potential risk exists from accidents while using routine office equipment or from storing and moving files.

Physical Requirements:

Position requires prolonged sitting, computer use, and some walking and standing.  Repetitive motion consists of extended periods of upper limb movements including arms, hands, and wrists. Good vision, good hearing, and clear speech required (all correctable).  Capable of lifting 30 pounds of weight or more on an occasional basis (such as boxes of supply items or stored records).


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