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Become A Reimbursement Specialist

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Working As A Reimbursement Specialist

  • Processing Information
  • Interacting With Computers
  • Getting Information
  • Performing Administrative Activities
  • Communicating with Supervisors, Peers, or Subordinates
  • Mostly Sitting

  • Repetitive

  • $40,063

    Average Salary

What Does A Reimbursement Specialist Do At Conduent

* Duties may include, but not limited to all or some of the following)
* Accurately interprets patient insurance, prescription and other health-related documentation
* Conducts medical and pharmacy benefit insurance verifications and investigations for commercial and government payors
* Communicates with insurance companies, patients, providers and prescribers to coordinate reimbursement and access solution
* Researches available alternative funding options to reduce patient’s financial burden
* Handles high call volumes in a call-center environment
* Communicates with internal and external departments to facilitate coordination of care
* Reports Adverse Events (AE) and Product Quality Complaints (PQC), as required and as per policy
* Strictly adheres to Standard Operating Procedures (SOPs)
* Analyzes records to transcribe appropriate ICD
* ICD-10, CPT, HCPCS codes
* Validates and enters prescription orders
* Completes casework in a timely manner with consistent follow-up as the accountable case manager
* Maintains patient confidentiality
* Advocates on behalf of the patient to problem-solve reimbursement and access issues
* Understands prescription drug benefit management techniques including Formularies, Prior Authorizations, etc.
* Performs clerical and administrative functions such as mailing and faxing correspondence, data entry, scheduling, etc.
* Validate licensed practitioners

What Does A Reimbursement Specialist Do At Option Care

* Follows up on invoices submitted to ensure prompt and timely payment and escalates issues as necessary.
* Evaluates payments/denials received for correctness and ensures that they are applied appropriately.
* Identifies bad debt write-offs and A/R adjustments.
* Initiates write-off and adjustments in accordance with policies and procedures.
* Ensures that secondary bills and patient invoices are accurately generated and submitted on a timely basis.
* Identifies any overpayments and/or duplicate payments, and investigates and resolves.
* Processes refund requests, in accordance with policies and procedures.
* Adheres to Regulatory / Payor Guidelines and policies & procedures.
* Supervisory Responsibilities:
* None

What Does A Reimbursement Specialist Do At Florida Hospital

* Demonstrates through behavior Florida Hospital’s Core Values of Integrity, Compassion, Balance, Excellence, Stewardship and Teamwork as outlined in the organization’s Performance Excellence Program
* Works with Insurance payors to ensure proper reimbursement on patient accounts to expedite resolution.
* Processes administrative appeals, refunds, reinstatements and rejections of insurance claims.
* Completes account follow up daily, maintaining established goal (s), and notifies Lead Rep, when necessary, of issues preventing achievement of such goal(s).
* Analyzes daily correspondence (denials, underpayments) to appropriately resolve issues.
* Responds to written correspondence received from Payor and/or Patients.
* Assists Customer Service area with patient concerns/questions to ensure prompt and accurate resolution is achieved.
* Analyzes previous account documentation, in order to determine appropriate action(s) necessary to resolve each assigned account.
* Initiates next billing, follow-up and/or collection step(s), not limited to calling Patients, Insurers or Employers, as appropriate.
* Remits initial or secondary bills to insurance companies.
* Documents the billing, follow-up and/or collection step(s) that are and all measures to resolve assigned accounts, including escalation to Supervisor if necessary.
* Remains in consistent daily communication with Insurance Reimbursement Supervisor and Lead Insurance Reimbursement Specialist regarding all aspects of assigned projects.
* Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level receiving information on account
* If you want to be a part of a team that is dedicated to delivering the highest quality in patient care, we invite you to explore the Insurance Reimbursement Specialist opportunity with Maitland and apply online today.
* Job Keywords:
* Billing, Patient Financial Services, Insurance Reimbursement

What Does A Reimbursement Specialist Do At Vanderbilt University Medical Center

* Coordinates the Vanderbilt billing process
* Accurately, efficiently and timely processing of claims, payments, refunds, denials, unpaid patient and insurance balances
* Accesses and takes corrective action, if necessary, of incoming financial data.
* Works account referred for follow-up in an accurate and timely manner
* Gives feedback to requesting party in a timely manner
* Provides accurate account maintenance and documentation sufficient for audit controls
* Maintains appropriate batching of financial transactions for imaging and audit purposes.
* Account documentations are timely and contain complete information
* Serves as liaison with insurance companies, third party payors, and administrative personnel, including Contracts Administration and customers.
* All necessary entities contacted to bring resolution to matter.
* Appropriately contacts proper entities with issues concerning their areas.
* Properly alert all areas affected by a particular situation
* Analyze incoming financial data to identify patterns from insurance carriers and/or other entities resulting in erroneous or no reimbursement
* Entire account audit performed
* Payer pattern(s) identified and addressed with payer
* Resolution of any issue(s) resulting in delayed or erroneous reimbursement
* Obtained proper payer reimbursement
* Identification of improper CPT 4/ICD 9 usage (APC, DRG) resulting in denial or erroneous reimbursement.
* Recognizes coding errors
* Has basic coding knowledge
* Utilizes coding software package
* Ability to identify improper coding linkage errors
* Ability to identify improper use of or needed modifiers
* Identify payers with/without contracts; interpret payer fee schedule on expected reimbursement
* Can correctly identify payers with whom Vanderbilt is contracted
* Identify erroneous reimbursement and adjustments according to fee schedule
* Address expected reimbursement guidelines to carrier, seeking further payment.
* Differential between payer edit errors and account specific payment error
* Prepare and maintain complex reports and records requiring the identification of sources, compilation, analysis and evaluation of data
* Ability to maintain data in appropriate source, i.e. spreadsheet.
* Can manipulate data, enabling the identification of patterns by multiple fields, i.e., CPT 4 codes, ICD 9 codes, payer
* Presentation of projects in appropriate format.
* Provide analytical and administrative support to special projects
* Assist supervisors with complex projects, i.e. audits, compliance issues.
* Update departmental policy and procedures
* In absence of supervisor, organize, schedule and monitor daily operations.
* Ability to apply managerial discretion when adjusting or approving adjustments to alter the financial balance of a patient account.
* Must meet productivity standards specific to the work unit guidelines
* TECHNICAL CAPABILITIES:
* CORE ACCOUNTABILITIES:
* CORE CAPABILITIES:
* High School Diploma or GED and 5 years relevant experience
* Licensure, Certification, and/or Registration (LCR

What Does A Reimbursement Specialist Do At Renown Health

* Adherence to Health Information Management (HIM) Coding policies.
* Adherence to The Joint Commission (TJC) and other third party documentation guidelines in an effort to continually improve coding quality and accuracy.
* Interprets and applies American Hospital Association (AHA) Official Coding Guidelines to articulate and support appropriate principal, secondary diagnoses and procedures.
* Responsibility for maintaining coding certification and referencing current ICD
* coding guidelines and regulatory changes.
* Contacts the appropriate charging department for assistance in obtaining physician clarification of diagnoses and/or procedures.
* Participates in performance improvement initiatives as assigned.
* This position is integral to the collaboration and teamwork with Clinical Documentation Improvement Department and interacts with health care givers as a team member striving to achieve quality patient care at Renown Health.
* The incumbent must consistently meet or exceed productivity and quality standards as defined by the HIM Coding Leadership.
* Telecommute is allowed with approval from HIM Management.
* KNOWLEDGE

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How To Become A Reimbursement Specialist

A high school diploma or equivalent is typically required for most financial clerk jobs. These workers usually learn their duties through on-the-job training.

Education

Financial clerks typically need a high school diploma or equivalent to enter the occupation. Employers of brokerage clerks may prefer candidates who have taken some college courses in business or economics and, in some cases, require a 2- or 4-year college degree.

Training

Most financial clerks learn how to do their job duties through on-the-job training. Some formal technical training also may be necessary; for example, gaming cage workers may need training in specific gaming regulations and procedures.

Advancement

Financial clerks can advance to related occupations in finance. For example, a loan interviewer or clerk can become a loan officer, and a brokerage clerk can become a securities, commodities, or financial services sales agent, after obtaining the required education and license.

Important Qualities

Communication skills. Financial clerks should have good communication skills so that they can explain policies and procedures to colleagues and customers.

Math skills. The job duties of financial clerks, including calculating charges and checking credit scores, require basic math skills.

Organizational skills. Strong organizational skills are important for financial clerks because they must be able to find files quickly and efficiently.

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Reimbursement Specialist jobs

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Reimbursement Specialist Career Paths

Reimbursement Specialist
Case Manager Program Manager General Manager
Account Manager
5 Yearsyrs
Collections Specialist Accounts Receivable Specialist
Accounts Receivable Manager
6 Yearsyrs
Collections Specialist Billing Specialist
Billing Manager
7 Yearsyrs
Accounts Receivable Specialist Accountant
Business Manager
7 Yearsyrs
Billing Supervisor Office Manager Business Office Manager
Business Office Director
8 Yearsyrs
Billing Manager Accounts Receivable Specialist
Business Office Manager
8 Yearsyrs
Medical Coder Adjunct Instructor Instructor
Chief Executive Officer
8 Yearsyrs
Collector Specialist Case Manager
Clinical Manager
8 Yearsyrs
Analyst Operations Analyst Intelligence Analyst
Collections Manager
5 Yearsyrs
Business Office Manager Business Manager Controller
Finance Services Director
10 Yearsyrs
Collector Account Manager Senior Manager
Managing Director
11 Yearsyrs
Case Manager Program Coordinator Assistant Director
Office Manager
5 Yearsyrs
Medical Coder Auditor Controller
Operations Manager
7 Yearsyrs
Finance Counselor Supervisor, Patient Access
Patient Care Manager
9 Yearsyrs
Insurance Verification Specialist Finance Counselor Service Supervisor
Patient Services Manager
8 Yearsyrs
Business Office Manager Accountant Staff Accountant
Payroll Manager
7 Yearsyrs
Finance Counselor Account Manager Business Manager
Practice Administrator
10 Yearsyrs
Billing Manager Business Office Manager Business Manager
Practice Manager
9 Yearsyrs
Billing Supervisor Billing Manager
Revenue Manager
8 Yearsyrs
Accounts Receivable Specialist Finance Analyst Finance Manager
Senior Manager
10 Yearsyrs
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Reimbursement Specialist Demographics

Gender

  • Female

    83.6%
  • Male

    14.5%
  • Unknown

    1.9%

Ethnicity

  • White

    80.6%
  • Hispanic or Latino

    11.1%
  • Asian

    6.3%
  • Unknown

    1.4%
  • Black or African American

    0.6%
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Languages Spoken

  • Spanish

    63.2%
  • French

    15.1%
  • German

    3.8%
  • Carrier

    3.8%
  • Chinese

    1.9%
  • Hindi

    1.9%
  • Portuguese

    0.9%
  • Filipino

    0.9%
  • Vietnamese

    0.9%
  • Bosnian

    0.9%
  • Tagalog

    0.9%
  • Urdu

    0.9%
  • Polish

    0.9%
  • Korean

    0.9%
  • Italian

    0.9%
  • Arabic

    0.9%
  • Croatian

    0.9%
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Reimbursement Specialist

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Reimbursement Specialist Education

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Real Reimbursement Specialist Salaries

Job Title Company Location Start Date Salary
Clinical Reimbursement Specialist North Westchester Restorative Therapy and Nursing Lake Mohegan, NY Nov 29, 2012 $87,000
Clinical Reimbursement Specialist North Westchester Restorative Therapy and Nursing Lake Mohegan, NY Nov 27, 2012 $87,000
Clinical Reimbursement Specialist North Westchester Restorative Therapy and Nursing Lake Mohegan, NY Dec 10, 2012 $87,000
Senior Reimbursement Specialist Lee Memorial Health System, A Special Purpose Unit Cape Coral, FL Nov 11, 2012 $72,301 -
$112,986
Reimbursement Specialist The Methodist Hospital Houston, TX Jun 13, 2011 $72,000
Reimbursement Specialist The Methodist Hospital Houston, TX Jun 06, 2011 $72,000
Provider Reimbursement Specialist United Healthcare Services, Inc. Columbia, MD Apr 26, 2016 $57,907 -
$63,000
Senior Reimbursement Specialist Lee Memorial Health System Cape Coral, FL Oct 01, 2010 $55,265 -
$84,635
Reimbursement Specialist Centra Health, Inc. Lynchburg, VA Oct 01, 2015 $44,408
Reimbursement Specialist I Healthsouth Corporation Birmingham, AL Aug 08, 2013 $43,600
Clinical Reimbursement Specialist RN Express Staffing Registry LLC New York, NY Oct 01, 2012 $43,500
Reimbursement Specialist Centra Health, Inc. Lynchburg, VA Oct 01, 2012 $42,825

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Top Skills for A Reimbursement Specialist

InsuranceCompaniesMedicare/MedicaidCustomerServicePatientAccountsCpt-4Follow-UpAccountsReceivablesMedicalRecordsHealthcareProvidersPharmacyDataEntryEOBInsuranceClaimsInsuranceVerificationAuditDurableMedicalEquipmentHcpcsInsuranceCarriersInsurancePayersFeeSchedules

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Top Reimbursement Specialist Skills

  1. Insurance Companies
  2. Medicare/Medicaid
  3. Customer Service
You can check out examples of real life uses of top skills on resumes here:
  • Major Functions: Prepared and submitted patient billing claims to Medicare and Medicaid as well as various Commercial Insurance Companies.
  • Initiated daily quality reviews of payer contracts, claim processing issues and eligibility and benefits for Medicare/Medicaid patients.
  • Be customer service oriented and maintain a professional approach regarding all matters.
  • Monitor and audit out of network claims, patient accounts and prepare detailed reports for management.
  • Worked with all Microsoft applications, Lotus Notes 123, ICD-9, CPT-4 coding and AS400 system.

Top Reimbursement Specialist Employers

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