Reimbursement Specialist

SUMMARY/OBJECTIVE:The Reimbursement Specialist responsible for all aspects of reporting the revenue for their assigned program, billing for claims, maintaining accounts receivable records and supporting peers for billing for other service lines as needed. The Billing Specialist, a key position in the Revenue Cycle, facilitates the claims process, including accurate and timely claims creation, follow-up and correspondence with department directors, providers, insurance inquiries and clients. The incumbent will assist in the clarification and development of process improvements and inquiries in order to maximize revenues. The Reimbursement Specialist expected to take initiative in order to service the client in the best possible manner, provide general administrative services to ensure policy compliance and facilitate processing of essential policy related documents. KEY FOCUS AREAS: World Class Customer ServiceKnowledge of claims review, analysis, accounting procedures and quality assuranceAccurate and Timely Claims SubmissionsAdvanced Excel spreadsheet capabilityEssential Functions (Job Duties) Prepares and submits clean claims to insurance payers via manual posting of claim payments, as well as importing/uploading electronic 835 files. Follows billing guidelines and legal requirements to ensure compliance with federal and state regulations. Responds to account inquiries from clients, payers, providers, and/or other staff as requested. Identifies and resolves client/insurance billing issues. Responsible for reviewing accounts which have been denied or underpaid by third party payers and resolves the issues resulting in denial/underpayment and handles formal appeals, if necessary. Works closely with team members regarding claim appeals, denials, resolution, and education. Performs and monitors all steps in the billing processes to ensure maximum reimbursement from clients, government and commercial payers as well as from special billing arrangements. Understands Medicare, Medicaid and other commercial payer rules and regulations applicable to billing. Updates senior leadership, department directors, staff, clients, and mangers of changes, as appropriate. Responsible for ensuring all clients, staff and providers are oriented to policies, procedures, coding, billing, and documentation compliance. Responsible for the continuing coding, billing, and documentation education for all providers, staff and clients. Understands the considerations of coding in Value Based payment contracts. Responsible for reviewing and implementing changes from payer bulletins. Uses online healthcare databases and other resources for verification and claim status. Delivers the highest quality service to internal and external customers. Must be comfortable working tight deadlines, have the ability to analyze and trouble shoot billing concerns and communicate concerns with leadership. Assists other members of the team with projects as needed. Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations. Other duties as assigned by management.

Created: 2025-06-14