Reimbursement Representative

Summary

U.S. Renal Care is a dialysis industry organization seeking a Reimbursement Representative to reconcile and review outstanding Medicare and commercial patient balances. The role handles claim rejections, denials, appeals, unpaid balances, billing corrections, and related reimbursement activities.

Responsibilities

• Reviews EOB/EOMB's for proper reimbursement
• Resolves electronic claim rejections and Explanation of Benefits denials in a timely manner
• Reviews and researches insurance correspondence and makes necessary corrections to ensure claims payment
• Follows up on unpaid/unresolved account balances, including claims rejected electronically, EOB denial and working A/R aging reports as directed. Provides insurance carriers with requested information to facilitate payment
• Regularly contacts Medicare, Medicaid and /or Commercial payors for resolution to claims not paid or claims not paid according to plan benefits
• Performs claim appeals as required
• Assists with credit balance resolution
• Completes re-bill request as necessary to facilitate timely and proper claims payment
• Follows up on unresolved account balances including RTP's
• Prepares adjustment and write-off requests as necessary
• Performs other duties and responsibilities as required or assigned

Skills

• High School diploma or GED require
• At least two years of experience in a health/medical billing and collection office
• Ability to use copier, fax machine, printer, calculator and multi-line telephone
• Must be proficient with computers with an understanding of medical billing software
• Advanced knowledge of medical terminology as well as knowledge of government and private insurer rules and regulations
• Advanced knowledge of CPT, ICD-9 and HCPCS coding as well as in-depth knowledge of medical billing requirements
• Working knowledge of Microsoft Outlook, Word and Excel
• Ability to utilize the internet, specifically Medicare and Medicaid websites
• Maintain confidentiality in regard to HIPAA rules and regulations, as well as private company matters

Qualifications

Must Haves

• High School diploma or GED require
• At least two years of experience in a health/medical billing and collection office
• Ability to use copier, fax machine, printer, calculator and multi-line telephone
• Must be proficient with computers with an understanding of medical billing software
• Advanced knowledge of medical terminology as well as knowledge of government and private insurer rules and regulations
• Advanced knowledge of CPT, ICD-9 and HCPCS coding as well as in-depth knowledge of medical billing requirements
• Working knowledge of Microsoft Outlook, Word and Excel
• Ability to utilize the internet, specifically Medicare and Medicaid websites
• Maintain confidentiality in regard to HIPAA rules and regulations, as well as private company matters

Benefits

• Full-Time employees are eligible for Medical / Pharmacy benefits.
• Full-Time employees are eligible for Dental benefits.
• Full-Time employees are eligible for Vision benefits.
• Full-Time employees are eligible for Voluntary benefits.
• Full-Time employees are eligible for a 401k with employer match.
• Full-Time employees are eligible for Virtual Care.
• Full-Time employees are eligible for Life Insurance.
• Full-Time employees are eligible for PTO.
• Part Time employees are eligible for a 401k with employer match.
• Part Time employees are eligible for PTO.