Reimbursement Specialist - Healthcare Appeals, A/R & Payor Collections

Core Duties/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.
• 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.

Skills / Requirements

• 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.

Education, Certifications and Experience

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

Physical Requirements

• 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.