Full-Time Reimbursement Specialist II - Pre Billing

As a Reimbursement Specialist II, you are a seasoned expert within the revenue cycle team, driving impact through deep knowledge of insurance processes, payer policy, and driving payment for our services. You play a key role in partnering with colleagues in Finance and Client Services while maximizing reimbursement outcomes for the organization.

Key Responsibilities:

• Analyze and interpret details from EOB/ERA files to ensure accurate posting of payments and adjustments against appropriate line-item service.
• Posting all denied charges for appeals department
• In-depth knowledge of healthcare remark/reason codes, advice codes, and definitions
• Familiarity with credits, debits, adjustments, takebacks, patient responsibility, allowed amounts, deductibles, co-pays, and coinsurance
• Understanding of denied charges, denial reasons, and claims adjudication processes
• Allocating Patient Payments to the appropriate account in a timely manner
• Manage credit card transactions including credits, refunds, and chargebacks
• Reconciling all bank transactions while meeting monthly deadlines
• Daily, monthly, quarterly, and annually reconcile credits and debit transactions received by the financial institution.
• Manage incoming correspondence from various channels (fax, email, portal) and associate them with the relevant patient/insurance records
• Communicate effectively with cross-functional teams to identify and address inefficiencies impacting ASP and claims adjudication processes
• Investigate and resolve credit balances, missing payments, payment allocations or discrepancies related to claims/appeals

Experience Requirements:

• 2-4 years recent experience in both professional and facility health care claims posting.
• Knowledge of health plan regulations and processes with high volume and/or multiple accounts.
• Experience with contacting and follow up with insurance carriers; national as well as regional payers throughout the country.
• Experience with managing incoming transactions from multiple lockboxes, ACH credit/debits, wire transfers, manage credit card processing with multiple gateways and merchant accounts as well as check scanners.
• Proficiency with revenue cycle tools, experience with laboratory reimbursement workflows, EDI enrollment, Payer Portal setup & management, Telcor, Waystar Clearinghouse, and Sarbanes Oxley controls (SOX) are highly desirable

Skills & Abilities:

• Exceptional attention to detail, self-motivated, organizational abilities, driven to identify process improvements
• Proficiency with using computer hardware and PC software, specifically Microsoft Office Suite, Adobe Acrobat PDF, particularly Excel
• Ability to work independently and handle confidential and sensitive information
• Excellent communication and interpersonal skills to facilitate collaboration

Additional Information:

• Hybrid Work Model
• US hourly range $22.39 to $30.79

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