Reimbursement Specialist - Healthcare Appeals & Collections

Summary

PRO-spectus is a healthcare-focused organization committed to improving the lives of patients. The Reimbursement Specialist II manages reimbursement operations by handling appeals, collections, billing and claims issues, payer communications, and account follow-up to support accurate reimbursement and positive cash flow.

Responsibilities

• Ensure timely collection of outstanding Accounts Receivable and resolution of billing/claims issues
• Research, evaluate, and interpret complex information relative to appeals, payor specific billing policies, and guidelines related to insurance
• Manage assigned accounts to ensure timely and appropriate actions are taken to ensure positive cash flow
• Required to stay up to date with changes in insurance policies and regulations that may affect reimbursement procedures which include commercial, Medicare, Medicaid and Workers Comp payers
• Identify any payments not made in accordance with contracted rates and fee schedules and properly escalate the incorrect payment to the payer
• Cross train to provide department coverage
• Varying clerical and light accounting work
• Additional duties may include data entry, record keeping, participating in projects, and other administrative support as needed
• As a remote-forward organization, this position operates in a professional office environment and teleworking from the employee’s home address listed in their employment file
• Prolonged periods of sitting at a desk and working on a computer
• Keyboarding
• Speaking
• Must be able to lift up to 15 pounds at times
• Flexibility of working hours to support activities across multiple Time Zones

Skills

• Extensive experience with appeals, payor specific billing policies, and guidelines related to insurance and collection follow-up
• In-depth understanding of healthcare billing and coding processes
• Ability to understand and navigate complicated insurance policies and regulations
• Excellent written and verbal communication skills throughout a variety of stakeholders, including insurers, patients, and healthcare providers
• Strong organizational skills, attention to detail, and effective task management while responding productively to changing priorities
• Remains calm and objective in emotional or stressful situations
• Learns quickly and applies innovative methods, tools, and technology to the role
• High level of self-accountability for compliance with policies, procedures, and work requirements
• Seeks advice when unsure about choosing a course of action
• Makes solid routine decisions with coaching from others
• Learns about the key drivers of the organization's business and uses those learns in the day-to-day work
• Maintains tenacity and work focus despite obstacles or setbacks and is comfortable dealing with first- time or unusual challenges
• Conversant with medical and billing terminology
• Expertise and knowledge of third-party payor
• Computer and database management skills to efficiently and effectively manage proprietary electronic systems
• Interpersonal and communication skills to effectively deal with a variety of people, including physicians, hospital leaders, nursing staff, patients, and family members
• High School Diploma with 5+ years' healthcare experience or an Associate's Degree in a healthcare-related field with 3+ years' experience
• As a remote-forward organization, this position operates in a professional office environment and teleworking from the employee's home address listed in their employment file
• Prolonged periods of sitting at a desk and working on a computer
• Keyboarding
• Speaking
• Must be able to lift up to 15 pounds at times
• Flexibility of working hours to support activities across multiple Time Zones
• Experience with payors and Clinical Guidelines or Medical Policy is preferred

Qualifications

Must Haves

• Extensive experience with appeals, payor specific billing policies, and guidelines related to insurance and collection follow-up
• In-depth understanding of healthcare billing and coding processes
• Ability to understand and navigate complicated insurance policies and regulations
• Excellent written and verbal communication skills throughout a variety of stakeholders, including insurers, patients, and healthcare providers
• Strong organizational skills, attention to detail, and effective task management while responding productively to changing priorities
• Remains calm and objective in emotional or stressful situations
• Learns quickly and applies innovative methods, tools, and technology to the role
• High level of self-accountability for compliance with policies, procedures, and work requirements
• Seeks advice when unsure about choosing a course of action
• Makes solid routine decisions with coaching from others
• Learns about the key drivers of the organization's business and uses those learns in the day-to-day work
• Maintains tenacity and work focus despite obstacles or setbacks and is comfortable dealing with first- time or unusual challenges
• Conversant with medical and billing terminology
• Expertise and knowledge of third-party payor
• Computer and database management skills to efficiently and effectively manage proprietary electronic systems
• Interpersonal and communication skills to effectively deal with a variety of people, including physicians, hospital leaders, nursing staff, patients, and family members
• High School Diploma with 5+ years' healthcare experience or an Associate's Degree in a healthcare-related field with 3+ years' experience
• As a remote-forward organization, this position operates in a professional office environment and teleworking from the employee's home address listed in their employment file
• Prolonged periods of sitting at a desk and working on a computer
• Keyboarding
• Speaking
• Must be able to lift up to 15 pounds at times
• Flexibility of working hours to support activities across multiple Time Zones

Nice to Haves

• Experience with payors and Clinical Guidelines or Medical Policy is preferred

Benefits

• Remote-forward organization with teleworking from the employee’s home address listed in their employment file.