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Top Reimbursement Specialist Skills

Below we've compiled a list of the most important skills for a Reimbursement Specialist. We ranked the top skills based on the percentage of Reimbursement Specialist resumes they appeared on. For example, 18.7% of Reimbursement Specialist resumes contained Insurance Companies as a skill. Let's find out what skills a Reimbursement Specialist actually needs in order to be successful in the workplace.

The six most common skills found on Reimbursement Specialist resumes in 2020. Read below to see the full list.

1. Insurance Companies

high Demand
Here's how Insurance Companies is used in Reimbursement Specialist jobs:
  • Requested and obtained prior determinations or authorizations for high dollar medications from insurance companies for physicians of multiple specialties.
  • Processed insurance claims to insure payment for medical services rendered and interfaced with insurance companies to resolve payment discrepancies.
  • Investigated insurance denials, corrected information to insurance companies and followed up on all outstanding insurance and patient payments.
  • Monitored and notified company of changes in reimbursement policies for government programs and private insurance companies.
  • Communicated with pharmacies, physicians and insurance companies to ensure proper medication assistance to patients nationwide.
  • Verified patients' medical and pharmacy benefits with insurance companies in order to maximize reimbursement solutions.
  • Reviewed customer statements and claims for accuracy before mailing or transmitting to insurance companies.
  • Received recognition from case managers at contracted insurance companies for my timeliness and professionalism.
  • Coded information about patient diagnoses and submitted formal payment requests to insurance companies.
  • Verified and figured correct reimbursement according to negotiate contract with insurance companies.
  • Reviewed claims returned or rejected by government or supplemental insurance companies.
  • Processed claims to primary and/or secondary insurance companies for anesthesia services.
  • Audited reimbursement from insurance companies and filed appeals when necessary.
  • Contacted insurance companies to verify eligibility coverage for drug benefits.
  • Worked closely with numerous insurance companies and maintained strict confidentiality.
  • Consulted insurance companies regarding outstanding medical balance and claims denials.
  • Provided tenacious follow-up for appeals filed with insurance companies.
  • Resolved payment discrepancies and entitlement issues with insurance companies.
  • Submitted claims and itemized billing statements to insurance companies.
  • Contacted insurance companies and verified patient benefits and eligibility.

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2. Medical Records

high Demand
Here's how Medical Records is used in Reimbursement Specialist jobs:
  • Performed audits of medical records to assess adequacy of documentation and accuracy of level of service and code selection.
  • Reviewed medical records and extracted information to apply medical codes that identified diagnoses, procedures and treatments.
  • Walked patients and providers through utilization management, obtaining medical records, expected benefits and payer interactions.
  • Provided supporting documentation, obtained medical records to justify claims for payment.
  • Researched account documentation to obtain medical records for current and retro authorizations.
  • Managed financial and medical records while scheduling appointments and processing refill request.
  • Printed medical records and other documentation needed for reimbursement.
  • Provided medical records to insurance carriers to expedite reimbursements.
  • Maintained confidentiality of all medical records and information.
  • Abstracted pertinent information from electronic medical records.
  • Utilized database to generate electronic medical records.
  • Reviewed denied claims with medical records to check for coding and posting errors, authorization, bundling, or carrier issues.
  • Obtained medical records when required by the insurance plan as well as required by the state and local government agencies.
  • Resolved reimbursement and coding issues related to professional service claims by utilizing the online medical records and billing systems.
  • Required to interface with QM, Finance and Medical Records personnel frequently and contribute to patient accounting reporting mechanisms.
  • Obtained medical records from hospitals and birthing centers under HIPPA guidelines to insure adequate appeal process on denials.
  • Requested from physicians any documents, prescriptions, medical records requested from insurance company to receive correct payment.
  • Transmitted correspondences and medical records by email, mail, and fax within the protected health guidelines.
  • Appealed under paid claims, provided medical records if necessary & faxed/mailed out documents depending on provider.
  • Complied and updated all medical records for patients, maintained all lab work and records.

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3. Customer Service

high Demand
Here's how Customer Service is used in Reimbursement Specialist jobs:
  • Facilitated in depth training of 30 customer service representatives that proactively resolved reimbursement escalations resulting in reduced time spent addressing inquiries.
  • Implemented training on customer service, alternative funding, insurance terminology, patient assistance and reimbursement protocols.
  • Recommended and implemented new business phone system to increase productivity, and improve customer service.
  • Resolved patient issues and concerns in a timely and professional manner promoting excellent customer service.
  • Assisted Customer Service area with patient concerns/questions to ensure prompt and accurate resolution is achieved.
  • Provided assistance to hundreds of customers regarding insurance coverage and customer service related issues.
  • Followed policies and procedures to achieve collection goals while providing excellent customer service.
  • Responded to inbound customer service calls and performed one-time resolution of accounts received.
  • Established a positive relationship with clients by providing overall superior customer service.
  • Developed and conducted a successful customer service training for four associates.
  • Provided customer service to hospital contracted insurance payers for account resolution.
  • Received recognition from customers and management for proving excellent customer service.
  • Demonstrated strong customer service skills in a professional telephone manner.
  • Performed customer service functions as required resulting in customer satisfaction.
  • Answered incoming calls demonstrating excellent customer service.
  • Provided internal coverage for customer service calls.
  • Provided superior customer service to incoming patients.
  • Maintained quality and quantity control/ satisfaction records, constantly seeking new ways to improve customer service in accounts payable and receivable.
  • Acted as a liaison between various departments including, but not limited to, eligibility, customer service, and finance.
  • Used good customer service and communication skills when working with insurance companies and patients to resolve issues concerning claims payment.

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4. CPT

high Demand
Here's how CPT is used in Reimbursement Specialist jobs:
  • Reconciled charges, daily coding audits and reimbursement analysis, coordination of master-file updates, fiscal year ICD-9 and CPT code updates
  • Based on basic proficiency in diagnosis coding (ICD-9) and procedural coding (CPT), resubmit for coding corrections.
  • Possessed intimate knowledge of ICD-9 and CPT coding and applying this knowledge to assist in building authorizations accurately and efficiently.
  • Researched, analyzed, and disseminated information to providers and staff regarding CPT and ICD-9-CM coding and compliance regulatory guidelines.
  • Reviewed documentation for proper utilization of ICD-9, CPT and HCPC coding methodologies; resolved outstanding issues.
  • Researched and provided Current Procedural Terminology (CPT) codes with description for key medically required services.
  • Worked with all Microsoft applications, Lotus Notes 123, ICD-9, CPT-4 coding and AS400 system.
  • Resolved problem claim issues (e.g., IDC-9 and CPT coding) for physicians and staff.
  • Billed patient and insurance carriers for Home Health Services by using ICD-9-CM and CPT coding practices.
  • Processed all charge entry functions ensuring that accurate and up to date CPT/ICD-10 codes are used.
  • Utilized my background in ICD-9 and CPT coding to resolve claim issues and decrease outstanding A/R.
  • Reviewed physician's documentation to assign ICD-9 and CPT codes reflecting physician's services.
  • Assigned appropriate ICD-9 and CPT codes to in-patient/outpatient consultations and clinic visits encounter forms.
  • Analyzed claims for non-payable ICD-9 Codes & CPT Codes and filed appeals.
  • Reviewed and processed CPT/HCPC and ICD 9 codes on unresolved claims.
  • Audited claims prior to submission for correct CPT and ICD codes.
  • Identified and defined appropriate CPT codes for existing and new services.
  • Trained new coders in correct application of CPT and ICD9 codes.
  • Maintained a working knowledge and understanding of CPT-codes and ICD-9 codes.
  • Corrected ICD-9 and CPT codes on claims that had been denied.

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5. Medicare

high Demand
Here's how Medicare is used in Reimbursement Specialist jobs:
  • Assisted medical device companies in obtaining Medicare reimbursement for new and emerging products as well as protecting reimbursement for established devices.
  • Resolved Medicare Part B billing discrepancies by researching suspends and compiling the necessary documentation to collect outstanding revenue.
  • Prepared financial models to estimate effect of changes in Medicare reimbursement methodologies on revenues for HealthSouth hospitals.
  • Streamlined process of preparing Medicare bad debt documentation for annual cost report by automating data collection efforts.
  • Facilitated Medicare Cost Reporting audits for five facilities, working directly with the external Medicare Auditors.
  • Identified and located medical policies for coverage or non-coverage of off-label diagnoses according to Medicare criteria.
  • Managed and evaluated all clinical documentation for Medicare and all third party related Medicare payers.
  • Participated in vendor/payer meetings and attended Medicare seminars to update billing procedures to maximize reimbursements.
  • Conducted daily reviews of Medicare electronic explanation of benefits to determine payment and non-payment statuses.
  • Educated Medicare providers regarding compliance issues relating to Medicare reimbursement guidelines including policy and coding.
  • Analyzed and calculated a dollar value for proposed audit adjustments submitted by Medicare Fiscal Intermediaries.
  • Analyzed and maintained contractual obligations with Medicare and private medical insurances through seminars and bulletins.
  • Provided reimbursement information to providers and patients, including private insurance and Medicare coding.
  • Compiled Medicare Cost Reports for nine outpatient rehabilitation facilities and one skilled nursing facility.
  • Verified Medicare patient benefits and eligibility, processed claims and assisted in claim reconciliation.
  • Watched for biannual Medicare policy updates and notified supervisor of developing Medicare reimbursement issues.
  • Monitored and conveying updates on industry regulations and developments in the Medicare/managed care environment.
  • Prepared the Medicare Cost Report for annual reimbursements Monitored insurance reimbursement rates and cash flow
  • Analyzed internal controls and verified compliance to Medicare regulations and Blue Cross requirements.
  • Coordinated 5 years of intermediary Medicare cost report reviews for dissolution of organization.

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6. Medicaid

high Demand
Here's how Medicaid is used in Reimbursement Specialist jobs:
  • Used knowledge about prior authorization processes for private insurance carriers and state Medicaid programs to ensure that beneficiaries received eligible coverage.
  • Verified Insurance Benefits and Authorizations out bound calls to all major insurance companies Medicare Medicaid both private and government insurance.
  • Designed and administered job selection exam to prospective employees during the interview process for the Medicaid Reimbursement Specialist position.
  • Managed a team that worked with Medicare and Medicaid regulations and created reimbursement methodology for facilities and ancillary providers.
  • Initiated daily quality reviews of payer contracts, claim processing issues and eligibility and benefits for Medicare/Medicaid patients.
  • Audited accounts to assure appropriate general ledger number was entered for accurate reporting to Medicare and Medicaid.
  • Completed patient s financial analysis to determine eligibility for various pharmaceutical assistance program and Medicaid Benefits.
  • Investigated up front denials through oral and written communication with Medicare, Medicaid, Private/Commercial Insurance.
  • Provided information and assisted patients with Medicaid eligibility referrals in a timely and complete manner.
  • Reviewed all insurance claims ensuring policy compliance and completeness for both Medicaid and Non-Medicaid billing.
  • Managed relationships with Virginia Medicaid, Connecticut Medicaid, West Virginia Medicaid and Delaware Medicaid.
  • Processed diabetic pump supply orders for Medicare and Medicaid patients adhering to government guidelines.
  • Composed appeals, denied letters to Medicaid using modifiers for specials deliveries and gynecology.
  • Submitted all claims to Medicare, Medicaid, primary insurances, and supplemental/secondary insurances.
  • Verified and updated required medical services reimbursement rates for Medicare and Medicaid by state.
  • Worked all levels of Medicare and Medicaid denied claims including reconsideration and medical appeal.
  • Processed Medicaid claims ensuring prompt payments and performed research relevant to payments as necessary.
  • Prepared and completed the Medicare Occupational Mix Survey and Medicaid Disproportionate Share Audits.
  • Verified patient information such as Medicaid and Medicare and all other insurance coverage.
  • Investigated patient insurance benefits with Medicare, Medicaid, and commercial insurance providers.

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7. Hcpcs

high Demand
Here's how Hcpcs is used in Reimbursement Specialist jobs:
  • Analyzed Oncologist, hospital requisitions forms, test panels for ICD-9, CPT coding & HCPCS.
  • Reviewed ICD-9/ ICD-10 and HCPCS codes to clinically qualify patients under Medicare Part B guidelines.
  • Maintained knowledge of CPT, ICD-9 coding, HCPCS, and medical terminology.
  • Researched claims billed by CPT/HCPCS code combination and ensuring proper coding.
  • Supplied HCPCS coding decisions results to internal and external customers.
  • Coded records using ICD-9-CM, HCPCS/CPT coding rules and guidelines.
  • Gained knowledge in LMRP's, CPT/HCPCS and ICD-9 coding.
  • Interpreted medical reports to apply appropriate ICD-9, CPT-4 and HCPCS codes.
  • Resolved issues with claims such as diagnosis and hcpcs codes.

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8. Icd-9

high Demand
Here's how Icd-9 is used in Reimbursement Specialist jobs:
  • Worked on the Urology ICD-9 to ICD-10 code conversion to better assist providers with the upcoming ICD-10 coding changes.
  • Assigned ICD-9 coding for appropriate terminal diagnosis (attended conferences for proposed ICD-10 coding in 2008 & 2009).
  • Added patient demographics in computer system, created and posted charges using ICD-9 and ICD-10 ICD codes.
  • Ensured accuracy of ICD-9 diagnosis codes and documentation of the OASIS-C prior to billing.
  • Assisted client physicians with ICD-9 CM diagnostic codes.
  • Applied ICD-9 and HCPC coding.
  • Researched medical insurance claims for physician payment Utilized ICD-9 and medical terminology
  • Performed compliance auditing, ICD-9-CM coding, insurance reimbursement and corrected/rebilled any coding errors for this busy OBGYN office.

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9. Party Payers

high Demand
Here's how Party Payers is used in Reimbursement Specialist jobs:
  • Prepared and submitted claims packages to third party payers and conducted appropriate follow-ups with responsible parties for timely collections.
  • Assisted with billing claims and completing follow-up activities on claims submitted to the third party payers.
  • Processed insurance claims, invoices, and resident statements for timely billing to third party payers.
  • Responded to requests from third party payers and / or patients regarding reimbursement problems and issues
  • Communicated with Medicare and other third party payers in regard to denials and offsets.
  • Obtained billing rules and guidelines for Managed Care Companies and Third Party Payers.
  • Submitted denials and appeals and worked with third party payers to maximize reimbursement.
  • Submitted medical claims to third party payers, while maintaining company productivity.
  • Communicated effectively with Physicians, insurance companies, and third party payers.
  • Submitted accurately and completed 1500 forms for Medicare and 3rd party payers.
  • Processed batch billing for third party payers and reconciled paid claims.
  • Processed billing for third-party payers and performed accounts receivable functions.
  • Served as liaison between departments and third-party payers.
  • Billed third party payers per contract.
  • Contacted insurance companies and third party payers regarding claim discrepancies and to obtain precertification.
  • Acted as a liaison between the business department, billers and third party payers in resolving billing and reimbursement accuracy.

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10. Patient Accounts

high Demand
Here's how Patient Accounts is used in Reimbursement Specialist jobs:
  • Researched and reprocessed outstanding aged charges for specific patient accounts; interacted daily with specific Medicare Carriers.
  • Processed transactions in patient accounts, including account setup, problem resolution and auditing transaction activity.
  • Coded patient accounts into company database to ensure consistent and accurate denial history.
  • Analyzed patient accounts, prepared monthly financial reports, supervised billing assistant.
  • Reviewed patient accounts to ensure accuracy and completeness of claims including benefits.
  • Processed transactions on patient accounts, problem resolution and auditing transaction activity.
  • Audited approximately 200 patient accounts for proper documentation and then billed electronically.
  • Reconciled and audited patient accounts to ensure compliance with Medicare regulations/laws.
  • Researched unidentifiable insurance company payments and posted to correct patient accounts.
  • Reconciled patient accounts for Florida-based home infusion services.
  • Updated patient accounts with additional insurance information.
  • Reconciled Medicare/Medicaid remittance advice to patient accounts.
  • Managed patient accounts, researched insurance coverage.
  • Managed patient accounts, processed payments to ensure clients were current to prevent outstanding debts; responsible for billing and collections.
  • Maintained a book of business of over $200,000 Accounts Receivable at any given time, exceeding 1000 patient accounts.
  • Established and implement appropriate billing procedures, and procedures for follow-up on third-party approvals and collection of overdue patient accounts.
  • Used Epic computer system to post insurance payments and discounts line by line per CPT code to patient accounts.
  • Researched and applied rejections, denials, deductibles, adjustments, reversals, and post payments to patient accounts.
  • Assisted in all phases of patient accounts operations to ensure the realization of the financial goals of the facility.
  • Handled patient accounts for the adult facility, psych facility, and children's hospital at Vanderbilt.

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Jobs With Trending Skills

11. Hipaa

high Demand
Here's how Hipaa is used in Reimbursement Specialist jobs:
  • Protected patient information and company assets by understanding and practicing HIPAA privacy rules while executing all patient related transactions.
  • Remained updated on changes and additions to HIPAA guidelines by participating in annual regulatory training.
  • Maintained patient profiles in accordance with standard operating procedures and remained within HIPAA regulations.
  • Maintained and ensured confidentiality of all patient information as required by HIPAA.
  • Maintained security and privacy of patient information by adhering to HIPAA regulations.
  • Maintained all patient confidentiality per HIPAA regulations.
  • Complied with HIPAA (Health Insurance Portability and Accountability Act) and other controls in all activities.
  • Educated employees on completing job tasks, and activities regarding confidentiality, and HIPAA policies.
  • Insured that all patient information is kept confidential and in compliance with HIPAA Guidelines.
  • Advised clients, physicians and staff of HIPAA Compliance Practices and ROI requirements.
  • Ensured department adhered to HIPAA, OIG, and compliance standards.
  • Attended HIPAA training and other training sessions as they arose.
  • Complied with all HIPAA regulations to provide patient privacy.
  • Ensured client confidentiality and compliance with HIPAA regulations.
  • Instituted office procedures for Medicare compliance and HIPAA.
  • Insured office practices were in compliance with HIPAA regulations
  • Maintained OIG Compliance and HIPAA Certified.
  • Processed payments from insurance companies Maintained strictest confidentiality; adhered to all HIPAA guidelines/regulations.
  • Ensured HIPAA compliance Demonstrated analytical and problem-solving Researched information to correctly submit claim
  • Complied with company mandatory HIPAA privacy program, business ethics, and complianceprogram.

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12. Account Balances

high Demand
Here's how Account Balances is used in Reimbursement Specialist jobs:
  • Researched overdue account balances and resubmitted underpaid claims for appeal per insurance guidelines.
  • Reviewed and expedited cumbersome account balances both written and verbally.
  • Collected patient account balances from contracted insurance companies.
  • Called insurance companies, third party administrators, and patient resolutions of outstanding account balances and claims.
  • Transferred account balances to secondary payers and balanced bill patients per state, pharmacies and company guidelines.
  • Researched and reconciled account balances from A/R over one million dollars reducing the receivables by over half.
  • Answered questions via telephone and email regarding account balances, insurance payments and billing practices.
  • Assisted patients in determining and initiating the appropriate action plan to resolve account balances.
  • Worked aging account balances from pivot table and denied remittance advice received.
  • Completed adjustments to account balances when necessary and responded to all messages.
  • Contacted patients to collect or arrange payments on outstanding account balances.
  • Researched any overdue account balances that were fully or partially unpaid.
  • Reconciled provider account balances according to the provider's contract.
  • Posted adjustments to reconcile account balances after payment posting.
  • Answered patient questions regarding their account balances.
  • Provided customers with data regarding account balances, payment options and credit policies.
  • Verified details of transactions, including funds received and total account balances.
  • Created monthly Excel lists of account balances .

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13. CMS

high Demand
Here's how CMS is used in Reimbursement Specialist jobs:
  • Identified and resolved issues with Outcome and Assessment Information Set (OASIS) data prior to CMS (Medicare) submission.
  • Analyzed & reviewed CMS 1500 claim forms for all errors; corrected forms as needed and resubmitted claims for payment.
  • Prepared CMS 1500 billing for infusion pharmacy electronic and paper claims for a variety of commercial and Medicaid insurance carriers.
  • Worked in the pediatrics dept, billed Medi-Cal/CCS for pharmacy and fusion billing, worked with the CMS 1500 forms.
  • Reconciled data and payments, and optimized plan payment revenue within CMS guidelines.
  • Maintained hospital charge master - Organized and filed hospital cost report to CMS
  • Retrieved unclean (UB04 and CMS1500 Claims) downloaded from Client's Hospital System (Van Wert of Ohio).
  • Transmited Palmetto denial claims to CMS for accounts payable with various insurance companies, while researching member accounts.
  • Selected Interface with CMS and AMA in reference to coding; submit legislative requests and coding updates.

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14. Data Entry

high Demand
Here's how Data Entry is used in Reimbursement Specialist jobs:
  • Handled inbound/outbound reimbursement and patient assistance program calls while performing benefit investigation and data entry.
  • Compiled and confirmed patient information via data entry for electronic submission of medical claims.
  • Provided data entry of approximately 1250 vouchers weekly.
  • Determined researcher who consistently identified data entry, date and or write off errors to insure they balanced daily.
  • Managed the following tasks: client satisfaction, problem reconciliation, and data entry in mainframe databases.
  • Worked on Direct Data Entry Access Team in requesting permission for other teammates.
  • Learned to use company's proprietary software for data entry and document preparation.
  • Performed data entry for patients and clients and consistently exceeded weekly goals.
  • Assisted in auditing data entry to ensure Department of Community Health compliance.
  • Verified patient benefits, completed data entry, and completed appropriate forms.
  • Performed daily data entry of denial codes into the billing software.
  • Reviewed data entry of services to ensure proper billing at month-end.
  • Acquired quick and accurate alpha/numeric data entry skills.
  • Processed claims, Data entry new prescriptions.
  • Verified patient's insurance eligibility and benefits for specialty drugs Data entry of benefits and eligibility into various computer software programs
  • performed data entry using various computer systems.
  • Processed paper claims and electronic work queues Reviewed bills for data entry accuracy, including authorizations and payments.
  • Maintained an exceptional data entry record while adhering to "clean claim" requirements.

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15. EOB

average Demand
Here's how EOB is used in Reimbursement Specialist jobs:
  • Analyzed patients accounts taking appropriate action for resolution, analyzed EOB/RA to ensure correct payment and required contractual allowances/adjustments are applied.
  • Filed level II-III appeal(s) based incorrect payments, EOB rejections, and other issues with accounts.
  • Worked with COB's and EOB's with different payers (including Government payers) on a daily basis.
  • Reviewed remittance codes from EOB's and R/A's to insure appropriate payment or to identify denials or non-payments.
  • Assisted Cash Application Department with post denials, zero payments from EOB's and scanned documents to them.
  • Followed up, Re-billed and appealed on unpaid, underpaid or partially paid claims per EOB's.
  • Collected pertinent data; reviewed the explanation benefits (EOB) to determine where possible recoveries exist.
  • Analyzed high dollar claims and explanation of benefits (EOB) to detect payment discrepancies.
  • Reviewed and interpret Explanation of Benefits (EOB) for denial and underpaid cods.
  • Reviewed EOP's/EOMB's and EOB for accuracy of insurance payments and patient responsibility.
  • Interpreted large volumes of EOB's and posted insurance and patient payments.
  • Reviewed claims and EOB's for issues and prepared appeals for denials.
  • Verified patients' EOB's eligibility and claims status with insurance agencies.
  • Filed EOB's, data entry, clerical, general office duties.
  • Updated information on multiple systems and printed out EOB's for providers.
  • Submitted Secondary claims - both electronic and paper attaching primary insurance EOB.
  • Analyzed EOB's correspondence to detect any discrepancies and reconcile accounts.
  • Received EOB's on payments made by insurance and client responsibilities.
  • Received all incoming EOB's and sorted accordingly.
  • Pulled EOB s for refunds and secondary insurance.

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16. Unpaid Claims

average Demand
Here's how Unpaid Claims is used in Reimbursement Specialist jobs:
  • Monitored unpaid claims by performing insurance follow up, initiating tracers and resubmitting claims as necessary.
  • Contacted Medicare regarding underpaid and unpaid claims.
  • Monitored accounts receivable and collected unpaid claims.
  • Researched, corrected, and resubmit or reprocess unpaid claims as necessary.
  • Checked status of any unpaid claims, partial pays or denials.
  • Followed up on Accounts Receivable of aged and unpaid claims.
  • Resolved unpaid claims via direct phone contact with insurance companies.
  • Reviewed, researched, and followed up on unpaid claims.
  • Worked unpaid claims through appeals process to achieve payment.
  • Promoted to Reimbursement Specialist to collect on unpaid claims.
  • Processed Medicare appeals on contested and unpaid claims.
  • Researched and refiled unpaid claims.
  • Created spreadsheets for unpaid claims.
  • Verified daily patients insurance Corrected denied claims/filed appeals Corresponded daily with insurance companies for status of unpaid claims.

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17. Billing System

average Demand
Here's how Billing System is used in Reimbursement Specialist jobs:
  • Identified and documented requirements for business reporting needs for new billing system.
  • Modernized billing process and executed electronic billing system.
  • Verified and entered financial information into billing system.
  • Maintained patient registration information in billing system.
  • Worked with Contract Administrators to ensure the payer's allowable by CPT code were accurately recorded in the billing system.
  • Administered Managed Care contract documentation for hospital DRG and Per Diem reimbursement in a networked billing system owned by HCA.
  • Tested and implemented processes for new billing system creating master files standardized for all national locations.
  • Assisted in the development of the process for IPRS, State Billing System for the agency.
  • Recommended new in-house billing system and clearinghouse to simplify the billing process for the office.
  • Ensured that all billing and collection activity is entered into the billing system correctly.
  • Ensured reconciliation among daily Accounts Receivables, billing system postings and bank deposits.
  • Corrected claims in electronic billing systems work list before submission to payer.
  • Assured charges were accurately coded and billed in the appropriate billing system.
  • Conducted education and training for 11 Family Health Centers on billing systems.
  • Tailored the process around the particular company and billing system available.
  • Trained new team members on department processes and billing systems.
  • Captured medical billing charges for LSU Healthcare clients using TES and IDX billing system.
  • Checked Emdeon the billing system for rejection issues on claims to resolve.
  • Experienced in billing claims through the Premis billing system.
  • Billed electronic bills to insurance company on billing system call MDX, coding with out of state claims.

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18. Appropriate Action

average Demand
Here's how Appropriate Action is used in Reimbursement Specialist jobs:
  • Analyzed current status assigned accounts and determined appropriate action to bring accounts to final adjudication.
  • Generated monthly reports identifying areas of concern to suggest appropriate action plans to enhance speedier reimbursement
  • Reviewed accounts receivable reports to identify issues and took appropriate action to promote reimbursement.
  • Reviewed Explanation of Benefits statements and take appropriate actions.
  • Analyzed daily billing edit reports for electronic claims, unpaid accounts to determine status and taking appropriate action to ensure payment.
  • Analyzed previous account documentation, in order to determine appropriate action(s) necessary to resolve each assigned account.
  • Reviewed all insurance denials, determined the appropriate action and re-filed all rejected claims with corrections as assigned.
  • Analyzed previous account documentation in WebMats /HIS to determine the appropriate action for account resolution.
  • Reviewed unpaid accounts to determine status and taking appropriate action to ensure payment.
  • Reviewed unpaid accounts, determined status, and took appropriate action.
  • Researched denials and determined appropriate action to take.
  • Researched cash application problems and took appropriate action.
  • Maintained strict confidentiality and adhered to all HIPAA guidelines and regulations Reviewed and interpreted rejected claims to determine appropriate action for re-filing
  • requested appropriate action including adjustments, refunds and collector follow up.

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19. Accounts Receivables

average Demand
Here's how Accounts Receivables is used in Reimbursement Specialist jobs:
  • Assisted Accounts Receivables department in securing payments from patient and reimbursements from insurance providers.
  • Performed in depth financial analysis of departments accounts receivables.
  • Reduced accounts receivables from over $600 thousand down to $30 thousand in five months.
  • Specialized in working aged accounts receivables greater than 90 days.
  • Conducted the research and reconciliations of DME accounts receivables.
  • Managed an accounts receivables balance of $1 million.
  • Managed Accounts Receivables for Medicare and Priority Health.
  • Managed accounts receivables for a specialty care pharmacy.
  • Completed accounts receivables and posted cash.
  • Managed accounts receivables, verified patients benefits and eligibility and obtained authorizations to ensure promptpayment.
  • Evaluated system-generated operating records and reports, and verified that the information was accurate for posting of accounts receivables'.
  • Managed the daily releasing of charges to Accounts Receivables.
  • Negotiated contract pricing with insurance companies Followed up Accounts Receivables Conducted monthly financial meetings with Director
  • Reduced aged accounts receivables for Acute County Hospital .
  • Maintained logs and distribution for all incoming claims Retro Authorizations Accounts Receivables Special Contract IV Billing
  • transferred out of state to another Company Facility) Reduced Accounts Receivables on assigned contracts.

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20. Healthcare

average Demand
Here's how Healthcare is used in Reimbursement Specialist jobs:
  • Obtained payer specific prior authorization procedures and documentation requirements and facilitated the prior authorization process for patients and healthcare providers.
  • Investigated complex healthcare reimbursement information, including managed care contracting and claims-related data for both private and government payers.
  • Transitioned employment to join Non Profit Healthcare System Quality and Reimbursement Team with priority on quality and reimbursement.
  • Assisted in credentialing department to maintain provider's credentialed status at healthcare facilities and contracted insurance companies.
  • Integrated Behavior Health-Claim Manager United Healthcare-Referral Proc.
  • Ensured collections on unpaid accounts over 90 days for one of the leading U.S. providers of home healthcare and wellness services.
  • Communicated with first party and third insurance companies, while performing administrative work in a healthcare setting.
  • Developed and implemented numerous slide presentations to address patient access issues and trends in the healthcare marketplace.
  • Worked with payers and healthcare professionals to resolve prior authorization issues and/or appeals of denials.
  • Coordinated and process requests from manufacturers, patients, physicians, and other healthcare professionals.
  • Worked with healthcare providers and patients to assist with appeal management for claim denials.
  • Handled prior authorization and submitted appeals in behalf of patients and other healthcare providers.
  • Ensured accurate, complete, and timely code assignments for all physician and healthcare providers
  • Served in various positions at a $1.0 billion healthcare organization.
  • Learned the ins and outs of the healthcare system.
  • Assisted with customer inquiries from members and healthcare providers.
  • Referred patients to appropriate healthcare services or resources.
  • Obtained and forwarded Prior Authorization/Formulary exception/Appeal requirements and documentation to healthcare providers.
  • Hired and supervised temporary employees on all projects as assigned by the client facility Dimensions Healthcare Training of Collections Department.
  • Tracked, and Recovered A/R through Limited partners (CTCA/Interim HC) All-encompassing comprehensive Reimbursement of Healthcare A/R.

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21. Timely Payment

average Demand
Here's how Timely Payment is used in Reimbursement Specialist jobs:
  • Worked closely with law offices and worker's compensation to ensure timely payment of claims.
  • Tracked outstanding invoices, researched credit memos and ensured timely payment of bills.
  • Followed up on submitted invoices to ensure prompt and timely payment.
  • Performed follow-up to ensure timely payment or to fight for back-payment.
  • Ensured prompt and timely payment of patient insurance claims.

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22. Outstanding Accounts

average Demand
Here's how Outstanding Accounts is used in Reimbursement Specialist jobs:
  • Communicated effectively with patients providing explanations of balance due, patient responsibility and collection efforts to reduce outstanding accounts receivable.
  • Worked Remotely-Posting of insurance claims and patient payments; reconciliation of daily deposits and monitoring of outstanding accounts receivable.
  • Followed up on outstanding accounts receivable and credit balances and ensure claims are on file with payer.
  • Contacted insurance carriers through website, email, or telephone to resolve outstanding accounts.
  • Decreased outstanding Accounts Receivable for West Coast district by 47% in four months.
  • Completed Collection letters on outstanding accounts or made phone calls for payments.
  • Obtained payment on outstanding accounts and/or accounts requiring deductibles or co-pays.
  • Worked special projects as needed to resolve outstanding accounts receivable.
  • Reviewed and collected on outstanding accounts.
  • Analyzed payers and patients outstanding accounts receivables, rebills, refunds, and denials in order to obtain maximum reimbursement.
  • Communicated with all privated insurance companies to collect on outstanding accounts over 180 days old.
  • Created AR reports to prioritize and collect on outstanding accounts for home infusion.

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23. MDS

average Demand
Here's how MDS is used in Reimbursement Specialist jobs:
  • Developed and maintained the schedule for all department heads adhering to the Minimum Data Set (MDS) participation.
  • Developed and provided education seminars for MDS documentation, process, ADL, and scheduling.
  • Completed MDS for OBRA and Skilled Rehab Clients.
  • Facilitated the conversion of 17 SNFs to a different MDS software system which boosted the RAI department's efficiency.
  • Collaborated, assessed and completed MDS schedule per RAI guidelines for 100-bed facility - Clinical documentation review.
  • Managed assessment schedule to ensure MDS assessments were completed on time and correctly.

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24. Reimbursement Issues

average Demand
Here's how Reimbursement Issues is used in Reimbursement Specialist jobs:
  • Assisted department manager in supervision and implementation of department protocols regarding revenue and reimbursement issues.
  • Developed strategies to resolve provider reimbursement issues and concerns to maximize product utilization.
  • Planned and attended payer meetings with insurance representatives to discuss current reimbursement issues.
  • Developed positive relationships with sales force by providing education on reimbursement issues.
  • Consulted with physicians on a monthly basis to review month end reports along with any coding and reimbursement issues.
  • Developed, implemented procedures of the Revenue Cycle and reimbursement issues.
  • Assisted doctor's offices with appeals process and reimbursement issues.
  • Performed analysis of the Hospital's third party Reimbursement issues.
  • Provided assistance with complex reimbursement issues via call center.
  • Assessed patient specific needs to resolve complex reimbursement issues.
  • Analyzed and reported carrier contract and reimbursement issues.
  • Contacted insurance companies to resolve drug reimbursement issues.
  • Identified provider enrollment and reimbursement issues in order to obtain insurance verifications.
  • Offered resolutions to all reimbursement issues prior to patient treatment requests including deductible and out of pocket expenses when applicable.
  • Researched, gathered data, organized & executed 'Special Projects' for reimbursement issues.

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25. Credit Balances

average Demand
Here's how Credit Balances is used in Reimbursement Specialist jobs:
  • Reviewed refund requests and reconciled credit balances.
  • Designed and implemented various spreadsheets using Excel to assist in resolving credit balances.
  • Researched credit balances; made decisions on appropriate distribution of excess funds.
  • Researched and processed credit balances by refund and/or adjustment reports.
  • Examined and resolved credit balances by verifying and issuing refunds.
  • Monitored credit balances and refunds.
  • Researched and processed credit balances.
  • Reviewed and Resolved credit balances.
  • Researched and resolved unapplied and credit balances.
  • Reduced outstanding receivables 30 days Audited private ledgers for accuracy and refunded credit balances Prepared unpaid balances for collections Processed bi-weekly payroll

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26. Benefit Investigations

average Demand
Here's how Benefit Investigations is used in Reimbursement Specialist jobs:
  • Completed Insurance Benefit Investigations (Insurance eligibility and coverage verification) to provide patients with the most accurate coverage information.
  • Conducted benefit investigations in order to assist case managers with obtaining services and benefits for patients with rare genetic disorders.
  • Completed benefit investigations, initiated prior authorizations, submitted claims, and assessed for ancillary programs.
  • Conducted benefit investigations and verified insurance benefits for patients & physicians' office.
  • Conducted benefit investigations for drug reimbursement and paid therapy for patients.
  • Performed benefit investigations based off of instructions from the Primary Care Physician
  • Completed patient profiles, Benefit Investigations, Obtained Prior Authorization requirements.
  • Performed Benefit Investigations for providers regarding a specific pharmaceutical.
  • Provided insurance benefit investigations to provider offices and pharmacies.
  • Performed benefit investigations on patient's insurance coverage.
  • Served as point of contact and subject matter expert in benefit investigations, increasing first touch resolution for the team.
  • Created job aid which helped team become more efficient with benefit investigations, decreasing benefits reporting turnaround time.
  • Performed benefit investigations, prior authorizations, appeals, claims, tracking and patient assistance.
  • Performed benefit investigations for Xolair, drug used to treat allergic asthma.

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27. Billing Process

average Demand
Here's how Billing Process is used in Reimbursement Specialist jobs:
  • Facilitated the clientele billing process by ascertaining invoice accuracy, adhering to strict contract interpretations and verifying documentation authenticity.
  • Assured completion of electronic billing processes so contracted treatment facilities would receive payment for services provided.
  • Researched all necessary information needed to complete billing processes.
  • Reduced billing cycle time by 15 days by simplifying billing process and improving credit / collection policies and procedures.
  • Ensured all errors in the McKesson enter services and scheduling are cleared for payroll and billing processing.
  • Applied Six Sigma and Lean methodologies to manage projects and implement medical billing process improvements.
  • Reviewed the rejection report to determine information needed to complete the billing process.
  • Coordinated and facilitated all aspects of the billing process for defined payers.
  • Coordinated the billing process between the Medical Center and the Payer.
  • Coordinated the billing process between Vanderbilt and, the payer.
  • Evaluated where there were internal problems within the billing process.
  • Assisted patients and insurance companies with billing processes.
  • Provided Customer Service to patients by answering questions regarding patient accounts and insurance billing processes.
  • Contacted the insurance company and coordinated the billing process for homebound patients.

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28. HMO

average Demand
Here's how HMO is used in Reimbursement Specialist jobs:
  • Assisted in verifying and transferring thousands of patient's from State Medicaid Programs to the elected or assigned HMO plans.
  • Negotiated out of network medical claims for national insurance companies, third party administrators, HMO s and unions.
  • Billed and pursued collections of all third party claims including Medicare, Medicaid, Commercial and HMO.
  • Resolved issues for customers dissatisfied with their HMO's regarding services, claims and other inquires.
  • Billed & collected on HMO contracts which included AV-Med & United Health Care.
  • Billed out over 2M monthly; Knowledge of Managed Care, Medicare, Medi-cal, Medi-Medi, HMO and Commercial Plans.
  • Monitored reimbursement status of Blue Cross, Aetna, United Health care, HMO, Medicare, and third party insurances.
  • Monitored collection & reimbursements of United Health care, HMO, Aetna and several other insurance accounts for home infusion services.
  • Posted insurance payments for Medicare, Bcbs, Medicaid, Medicaid HMO's and commercial insurances.

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29. Appropriate Reimbursement

low Demand
Here's how Appropriate Reimbursement is used in Reimbursement Specialist jobs:
  • Facilitated insurance carriers and the Business Office procedures to facilitate appropriate reimbursement for the Neurosurgery department.
  • Ensured timely delivery of insurance bills and followed up for appropriate reimbursement.
  • Examined claims to determine appropriate reimbursement based on the contractual agreement.
  • Monitored contracts and single patient agreements to ensure appropriate reimbursement.
  • Audited accounts to insure appropriate reimbursement by medical insurance payers.
  • Recommended appropriate reimbursement rates and quantified the cost impact based on the analysis of claims and provider input.
  • Initialized the next billing, follow up and /or collection procedure for appropriate reimbursement.
  • Saved insurers from paying more than appropriate reimbursement.
  • Ensured optimum appropriate reimbursement from third party payers.

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30. Fee Schedules

low Demand
Here's how Fee Schedules is used in Reimbursement Specialist jobs:
  • Determined regional/cap/business indicators for multiple business areas to assure accurate reimbursement based on provider contract and area fee schedules.
  • Negotiated insurance contracts including fee schedules and verified contractual obligations and participating provider agreements.
  • Developed fee schedules, monitored and maintained reimbursement profiles.
  • Maintained fee schedules for payment/coding information.
  • Performed monthly and quarterly audits of fee schedules to insure reimbursement is in line with DMS and CMS reimbursement methodologies.
  • Maintained fee schedules and monitored payments on accounts; making sure claims were being paid according to contracts.
  • Obtained working knowledge of the terms and fee schedules for all contracts for which invoices were submitted.
  • Ensured contract fee schedules were updated accurately and timely for revenue cycle department training and reference.
  • Worked with master files updating multiple fee schedules into the billing system and applied necessary adjustments.
  • Ensured proper payment of CPT codes in accordance with correct fee schedules and contract agreements.
  • Managed the maintenance of fee schedules for updates, distributions, and contract retention.
  • Managed the terms and fee schedules for all contracts in which invoices were submitted.
  • Obtained current fee schedules and ensured contracts were loaded accurately into the system.
  • Pulled contract fee schedules and reviewed documentation for discrepancies on pended claims.
  • Followed up on denied appeals, claims and contract fee schedules.
  • Researched fee schedules for low reimbursement projects.
  • Reduced returned claims from Medicaid by nearly 95% Renegotiated fee schedules with dozens of insurances/worker s compensation.
  • Reviewed fee schedules per payor contract and ensured claim processed according to member benefits for multiple contracts.
  • Conducted rolling product pricing audits using contracts and fee schedules.
  • Maintained fee schedules in Central Provider File, Cigna Claims, Medicom, Fee Schedule System, and Proclaim systems.

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31. Customer Billing

low Demand
Here's how Customer Billing is used in Reimbursement Specialist jobs:
  • Provided claim retrieval and collections for exhausted claims and unpaid customer billing.
  • Handled customer billing and payments Processed and approved financial aid applications.
  • Checked for proper coding of equipment, Ran Mestamed software program, handled customer billing questions.
  • Assisted Sales Representatives in resolving customer billing issues which involved research of billing systems and auditing of contract and promotion implementation.
  • Performed customer service interface to assure order accuracy, product availability, delivery scheduling and customer billing.
  • Completed advanced billing issues including making adjustments concerning customer billing for both commercial and residential accounts.

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32. Patient Demographics

low Demand
Here's how Patient Demographics is used in Reimbursement Specialist jobs:
  • Updated patient demographics, collected and posted payments to patient's accounts.
  • Audited patient demographics & billed charges, making corrections as needed.
  • Entered patient demographics and charges for claim submission.
  • Verified/entered patient demographics including insurance authorizations and eligibility.
  • Verified patient demographics, determined insurance eligibility and benefit coverage for patients admitted to the facility for inpatient and outpatient activity.
  • Verified insurance eligibility and benefits, entered patient demographics, scheduled appointments, maintained files, sent out referrals.

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33. Patient Care

low Demand
Here's how Patient Care is used in Reimbursement Specialist jobs:
  • Established communication with patient insurance parties for service authorization of patient care.
  • Coordinated patient care from intake to discharge, including physician orders, insurance benefits, authorizations and invoice editing.
  • Worked closely with Pharmacy and Nursing to ensure patient care was documented according to government and contracted payer guidelines.
  • Maintained and exceeded expectations in patient care planning to ensure a high quality of care.
  • Coordinated patient care for enteral nutrition needs from hospital discharge to home set up.
  • Obtained insurance verification and medical benefit authorization with regard to outpatient care, including benefits for evaluation, treatment and testing.

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34. Durable Medical Equipment

low Demand
Here's how Durable Medical Equipment is used in Reimbursement Specialist jobs:
  • Calculated allowances for drugs used with durable medical equipment.
  • Billed health insurances for Infusion, Home Health, and Durable Medical Equipment for the Central Valley.
  • Translated location data into standardized codes for skilled nursing, durable medical equipment and pharmacy charges.
  • Verified coverage using various payer internet sites to ensure proper payment for durable medical equipment.
  • Participated in performance improvement program; online Durable Medical Equipment (DME) training.
  • Obtained health insurance benefit quotes for sleep studies and durable medical equipment.
  • Submitted billing for durable medical equipment and supplies.
  • Inspected documentation for approved durable medical equipment confirming there was no duplication of equipment thereby ensuring payment.
  • Ascertained the validity of every CMN (initial, revised or recertified) for all Durable Medical Equipment.
  • Followed up with carriers regarding the status of Preauthorization and Predetermination to obtain approvals for durable medical equipment.

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35. Inbound Calls

low Demand
Here's how Inbound Calls is used in Reimbursement Specialist jobs:
  • Received Inbound calls from Physicians/Patients/Payers to specified customers.
  • Worked within the call center while handling 50-75 inbound calls per day.
  • Handled inbound calls from patient on self pay balance.
  • Received inbound calls on specialty medication drugs.
  • Accepted inbound calls from customers regarding statuses.
  • Provided assistance with reimbursement inquiry requests Handled patient inbound calls and verified insurance benefits.
  • Attended bilingual high call volume of inbound calls, for fast pace and growingorthopedic practice.

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36. Proper Reimbursement

low Demand
Here's how Proper Reimbursement is used in Reimbursement Specialist jobs:
  • Resubmitted denied claims for proper reimbursement.
  • Prepared annual Disproportionate Share (DSH) Surveys to ensure facilities were receiving proper reimbursement.
  • Processed insurance billing, follow-up, and adjustments to ensure proper reimbursement.
  • Followed up on all correspondence and denials to ensure proper reimbursement.
  • Tracked claims and assured proper reimbursement was received from insurance.

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37. Accurate Billing

low Demand
Here's how Accurate Billing is used in Reimbursement Specialist jobs:
  • Updated patient demographics and insurance to ensure accurate billing.
  • Ensured accurate billing by monitoring patient data.
  • Assisted staff of 2 for accurate billing and prompt collections for Three Home Health Companies.
  • Performed reimbursement functions with focus on collections through complete and accurate billing.
  • Corrected accounts for accurate billing and coding.
  • Reviewed client invoices for accurate billing practices.

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38. PPO

low Demand
Here's how PPO is used in Reimbursement Specialist jobs:
  • Worked collaboratively with Eligibility Systems Analysts, other Eligibility Associates, Eligibility Managers and Account Managers to provide seamless support.
  • Supported processing of electronic and paper claim submissions for primary and secondary carriers in a regulated and deregulated environment.
  • Monitored operation of support departments to ensure that resident needs were met and facility was properly maintained.
  • Developed rapport and strong communication channels with Clinical Review team to ensure continuity of notification/ coding process.
  • Provided high-quality customer service while supporting Reimbursement Specialists for escalation issues and providing guidance on future escalations.
  • Worked in a team environment to educate and support assigned Filed Representatives regarding Skilled Nursing Facilities.
  • Supported facility contracting department by completing the negotiated payment rate exhibit, using negotiated rate proposal.
  • Utilized coding methodologies to analyze clinical data, verify billing accuracy and to support cost containment.
  • Provided direct administrative support for the University of Texas Physicians, department administrator and assigned faculty.
  • Developed educational materials related to documentation, compliance and reimbursement for all physicians and support staff.
  • Processed written appeals and telephone appeals with supporting documentation to various insurance companies and government payers.
  • Participated in internal and external educational opportunities relevant to the reimbursement or customer service environment.
  • Supported contract director, prepared applications and gathered supporting documents for third party payer credentialing.
  • Recommended and supported reimbursement strategy refinements in line with industry trends and Network Development goals.
  • Supported Marketing, Research and Development scientists as well as Manufacturing and Warehouse operations.
  • Communicated effectively with senior level management, executives, physicians, and supporting auxiliary.
  • Discovered provider error trends which resulted in incorporating more educational opportunities for clinical staff.
  • Maintained database of physician credentialing and appointments as well as completed licensing requirements.
  • Scheduled appointments and followed up with patients to ensure customer satisfaction and retention.
  • Supported sales goals by securing authorizations and delivering the highest level of reimbursement.

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39. Hippa

low Demand
Here's how Hippa is used in Reimbursement Specialist jobs:
  • Mailed letters to customers requesting missing information to complete order according to HIPPA and Medicare regulation.
  • Maintained knowledge base of proper billing procedures according to HIPPA and other regulatory requirements.
  • Maintained strictest confidentiality according to HIPPA guidelines.
  • Monitored, maintained and updated customer files for accuracy and quality assurance purposes as well as to meet HIPPA standards.
  • Provided training for new employees on infusion medical billing programs, collection procedures, and HIPPA regulations.
  • Maintained stringent practices to protect the clients PHI as defined and governed by the HIPPA laws.
  • Assisted with implementation of HIPPA policies, procedures and guidelines for all offices.
  • Regulated and enforced HIPPA policies and guidelines throughout the entire department.
  • Ensured all company procedures are HIPPA compliant at all times.
  • Established automatic remit batch posting, HIPPAA transaction set 835.
  • Developed and implemented HIPPA training, testing and compliance
  • Adhered to the HIPPA privacy and security regulations
  • Obtained high-volume of prior authorizations, verifying pharmacy and medical benefits for maintaining HIPPA regulations.

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40. Electronic Claims

low Demand
Here's how Electronic Claims is used in Reimbursement Specialist jobs:
  • Scanned patient medical documentation and attached to electronic claims submissions.
  • Reviewed daily billing reports ensuring the accuracy of electronic claims.
  • Worked electronic claims transmission rejections.
  • Verified insurance benefits, filed claims and performed follow-up for payment; Instrumental in bringing electronic claims submission on-line for group.
  • Applied insurance checks and patient payments to individual accounts, reconciled month-end totals utilizing Excel, and transmitted electronic claims.
  • Focused on electronic claims submission to increase cash flow and reduce the number of denials and appeals.
  • Processed paper and electronic claims complete with denials and appeals.
  • Reviewed daily billing, edit reports for electronic claims.
  • Attained experience with paper and electronic claims filing.

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41. Delinquent Accounts

low Demand
Here's how Delinquent Accounts is used in Reimbursement Specialist jobs:
  • Coordinated collection activities for delinquent accounts by preparing information for collection agencies.
  • Reviewed Aging Report and identified delinquent accounts in Medical Manager.
  • Directed correspondence in initial stages of delinquent accounts.
  • Researched and re-billed delinquent accounts for reimbursement.
  • Notified collection agency of delinquent accounts.
  • Performed collections process for delinquent accounts to be sent to the outside collection agencies or vendors.
  • Reduced outstanding collections from 30 to 20% of aging delinquent accounts over 120 days.
  • Reviewed delinquent accounts to determine financial status for corrective action to ensure A/R.
  • Recouped losses from rejected claims, made payment arrangements for delinquent accounts.
  • Managed delinquent accounts by mail and telephone in order to solicit payment.
  • Performed collections for delinquent accounts, collect payments and posted cash.
  • Appealed delinquent accounts and followed up regularly for payment.
  • Worked delinquent accounts and coded the family practice charges.
  • Performed collection of medical debt to achieve positive resolutions throughout a multi-million dollar queue of delinquent accounts.
  • Reviewed work queues to identify delinquent accounts with require follow-up action according to pre-established criteria.
  • Liaised with Department of Banking and Insurance regarding scheduling arbitrations for delinquent accounts.
  • Contacted customers (inbound and /or outbound) to resolve delinquent accounts using the telephone/dialer.

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42. Hcfa

low Demand
Here's how Hcfa is used in Reimbursement Specialist jobs:
  • Verified and confirmed patient eligibility and insurance benefits, processed HCFA 1500 and UB04Other responsibilities
  • Analyzed HCFA 1500 forms and specialized in negotiating payment from Blue Cross Blue shield branches in varying states including Florida Blue.
  • Established preliminary settlements of amounts due to or from the Health Care Financing Administration (HCFA) accurately and timely.
  • Corrected errors in patient's accounts and mailed revised statements and HCFA 1500forms to patients and respective insurance companies.
  • Billed claims electronic via ENS, DayTek, TMHP, Health Fusion and mailed out HCFA1500 forms to payers.
  • Completed and submitted for reimbursement the HCFA 1500, MA 319 and UB-92 claim forms to various carriers.
  • Billed out over 500 itemized claims a month on 1500 HCFA forms, both electronically and paper.
  • Billed claims to insurance companies using UB92 and HCFA 1500 forms and ensures correct payments were made.
  • Billed out over 700 claims monthly on 1500 HCFA forms, both electronically and paper.
  • Contacted insurance companies to investigate claim denials, and resubmit corrected UB92/HCFA claims.
  • Reviewed the billing using paper and electronic HCFA 1500 and UB92 forms.
  • Printed UB-04 and HCFA 1500 Claims and distributing to insurance carriers.
  • Completed and filed HCFA medical forms for various physicians' services.
  • Entered data and transmitted insurance claims using HCFA 1500 forms.
  • Processed claims with HCFA, UB92 and Paid Prescription forms.
  • Filed HCFA and UB-04 claim forms with all needed attachments.
  • Processed electronic and HCFA/UB professional and unskilled claims.
  • Completed insurance contracts Analyzed reimbursement data Facilitated communication between insurance carriers and City of Faith Reviewed HCFA and UB82 claims for accuracy

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43. Financial Assistance

low Demand
Here's how Financial Assistance is used in Reimbursement Specialist jobs:
  • Worked with non-profit patient assistance programs to facilitate or verify financial assistance and insurance coverage for patient's copay.
  • Gathered and evaluated required documentation in an effort to determine patients' eligibility for financial assistance.
  • Assisted patients with application for financial assistance and referral to various community funded programs.
  • Provided caller with accurate information about financial assistance when applicable.
  • Researched and obtained financial assistance for under insured patients.
  • Gathered documentation and processed Financial Assistance applications.
  • Worked as a team alongside Case Managers to ensure Patients are eligible for financial assistance if needed.
  • Calculated the estimated cost of therapy for patients and found financial assistance for patients in need.
  • Aided patients with arranging payment options or applying for financial assistance.
  • Referred patients for financial assistance if needed.
  • Assisted with payment plans and financial assistance.
  • Worked with nonprofit patient assistance program, which provided financial assistance and helped with patients' copays.

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44. Cigna

low Demand
Here's how Cigna is used in Reimbursement Specialist jobs:
  • Maintained hospital and ancillary contract parameters in the Central Provider File, CIGNA Claims,
  • Achieved an over turn rate greater than 65% for CIGNA at the external medical review level.
  • Researched and analyzed previous contracts to ensure 50% zero critical defects with CIGNA submission standards.
  • Negotiated claim settlements with insurance company's such as Anthem Blue Cross, Aetna, and Cigna.

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45. Ensure Accuracy

low Demand
Here's how Ensure Accuracy is used in Reimbursement Specialist jobs:
  • Reviewed and audited medical claims submitted by non-plan providers to ensure accuracy and appropriateness of charges submitted.
  • Processed expense reimbursement and reviewed each respective submission to ensure accuracy.
  • Reviewed clients' weekly billing to ensure accuracy and adherence to company compliance standards and contractual agreements.
  • Analyzed and reviewed 2 to 3 contract batches daily to ensure accuracy of quality errors.
  • Maintained a spreadsheet of general ledger and ensure accuracy of data for financial tracking.
  • Created procedures in order to maintain proper documents to ensure accuracy for payroll.
  • Monitored payable files to ensure accuracy.
  • Provided operations management and financial reporting to ensure accuracy in customer orders and fiscal capacity.
  • Worked closely with the Marshfield Clinic Accounting Department to ensure accuracy and deadlines.

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46. Clean Claims

low Demand
Here's how Clean Claims is used in Reimbursement Specialist jobs:
  • Prepared and submitted clean claims to various payers including Medicare, Medicaid, and managed care either electronically or by paper.
  • Participated in a 6-week project to ensure clean claims going forward after implementation of a new system.
  • Performed quality control edits to make sure that clean claims were sent electronically to the insurance carriers.
  • Submitted clean claims to government, commercial, and third party payers for processing and payment.
  • Developed the accurate clean claims and submitted to third party payers and patients.
  • Processed timely and accurate submission of clean claims per guidelines and contracts.
  • Submitted clean claims to HMO/PPO and third-party payers via paper or electronically.
  • Prepared and processed clean claims.

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47. Payment Arrangements

low Demand
Here's how Payment Arrangements is used in Reimbursement Specialist jobs:
  • Contacted clients for payment or make payment arrangements to keep account in good standing.
  • Contacted patients to set up payment arrangements on past due medical accounts.
  • Negotiated contracts with commercial payers and set up payment arrangements with patients.
  • Discussed billing issues with patients or members, including payment arrangements.
  • Managed daily collection reports and set up collection payment arrangements, as well as explained insurance payments and patient responsibility.
  • Provided financial counseling to patients, setting payment arrangements, assisting with charity programs and other government assistance.

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48. Billing Department

low Demand
Here's how Billing Department is used in Reimbursement Specialist jobs:
  • Systematized accounts payable and accounts receivable for medical billing department.
  • Supervised billing department, accounts receivable and collections.
  • Formulated a month end target required to be met by billing department; achieved target 95% of employment.
  • Assisted billing department with various coding, policy and payment issues.
  • Worked in the billing department as a collector.
  • Acted as a liaison to the billing department.
  • Managed the coding/billing department of a multi-specialty clinic.

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20 Most Common Skill For A Reimbursement Specialist

Insurance Companies18.7%
Medical Records10%
Customer Service7%
CPT5.8%
Medicare5.4%
Medicaid5.4%
Hcpcs3.3%
Icd-92.8%

Typical Skill-Sets Required For A Reimbursement Specialist

RankSkillPercentage of ResumesPercentage
1
1
Insurance Companies
Insurance Companies
18.7%
18.7%
2
2
Medical Records
Medical Records
10%
10%
3
3
Customer Service
Customer Service
7%
7%
4
4
CPT
CPT
5.8%
5.8%
5
5
Medicare
Medicare
5.4%
5.4%
6
6
Medicaid
Medicaid
5.4%
5.4%
7
7
Hcpcs
Hcpcs
3.3%
3.3%
8
8
Icd-9
Icd-9
2.8%
2.8%
9
9
Party Payers
Party Payers
2.5%
2.5%
10
10
Patient Accounts
Patient Accounts
2.3%
2.3%
11
11
Hipaa
Hipaa
2.3%
2.3%
12
12
Account Balances
Account Balances
2.2%
2.2%
13
13
CMS
CMS
2.1%
2.1%
14
14
Data Entry
Data Entry
2.1%
2.1%
15
15
EOB
EOB
2%
2%
16
16
Unpaid Claims
Unpaid Claims
1.7%
1.7%
17
17
Billing System
Billing System
1.5%
1.5%
18
18
Appropriate Action
Appropriate Action
1.4%
1.4%
19
19
Accounts Receivables
Accounts Receivables
1.4%
1.4%
20
20
Healthcare
Healthcare
1.3%
1.3%
21
21
Timely Payment
Timely Payment
1.2%
1.2%
22
22
Outstanding Accounts
Outstanding Accounts
1.1%
1.1%
23
23
MDS
MDS
1%
1%
24
24
Reimbursement Issues
Reimbursement Issues
1%
1%
25
25
Credit Balances
Credit Balances
1%
1%
26
26
Benefit Investigations
Benefit Investigations
0.8%
0.8%
27
27
Billing Process
Billing Process
0.8%
0.8%
28
28
HMO
HMO
0.8%
0.8%
29
29
Appropriate Reimbursement
Appropriate Reimbursement
0.8%
0.8%
30
30
Fee Schedules
Fee Schedules
0.8%
0.8%
31
31
Customer Billing
Customer Billing
0.8%
0.8%
32
32
Patient Demographics
Patient Demographics
0.7%
0.7%
33
33
Patient Care
Patient Care
0.7%
0.7%
34
34
Durable Medical Equipment
Durable Medical Equipment
0.7%
0.7%
35
35
Inbound Calls
Inbound Calls
0.6%
0.6%
36
36
Proper Reimbursement
Proper Reimbursement
0.6%
0.6%
37
37
Accurate Billing
Accurate Billing
0.6%
0.6%
38
38
PPO
PPO
0.6%
0.6%
39
39
Hippa
Hippa
0.5%
0.5%
40
40
Electronic Claims
Electronic Claims
0.5%
0.5%
41
41
Delinquent Accounts
Delinquent Accounts
0.5%
0.5%
42
42
Hcfa
Hcfa
0.5%
0.5%
43
43
Financial Assistance
Financial Assistance
0.5%
0.5%
44
44
Cigna
Cigna
0.5%
0.5%
45
45
Ensure Accuracy
Ensure Accuracy
0.4%
0.4%
46
46
Clean Claims
Clean Claims
0.3%
0.3%
47
47
Payment Arrangements
Payment Arrangements
0.3%
0.3%
48
48
Billing Department
Billing Department
0.3%
0.3%

11,245 Reimbursement Specialist Jobs

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