What does a reimbursement specialist do?
A reimbursement specialist is responsible for analyzing insurance documents, processing reimbursement claims, and releasing accurate billing statements for insurance claims. Reimbursement specialists must have excellent analytical skills, especially on performing clerical tasks to evaluate insurance cases, investigate cases, and update the account information of the clients on the database. They should also have impeccable communication skills and understanding of the insurance processes to be able to coordinate with the clients, explaining the procedures of their claims accurately, and coordinate with the insurance management to improve the claims processes.
Reimbursement specialist responsibilities
Here are examples of responsibilities from real reimbursement specialist resumes:
- Manage the EDI clearinghouse rejections.
- Process department payroll, order supplies, and manage petty-cash funds.
- Manage use of various systems, such as MEDITECH, Cerner, WebNow, and yield-base follow-up tool.
- Manage cases by aggressively directing the litigation process.
- Negotiate fee structure for manage care contracts on acute and rehabilitation facilities.
- Research medical coding ICD-9, ICD-10, HCPCS and CPT-4 to let client know the outcome of medical claim.
- Process claims and ensure appropriate use of ICD-9 and HCPCS codes, and accuracy of infusion pricing, HIPAA compliance educate.
- Prepare and submit accurate claims with appropriate HCPCS codes and modifiers on DME equipment and supplies to insurance carriers.
- Key payments into system to allow posting to individual patients and dates of service per the payer's EOB.
- Reconcile charges, daily coding audits and reimbursement analysis, coordination of master-file updates, fiscal year ICD-9 and CPT code updates
- Review claims to ensure the correct ICD-9 and CPT codes are reported to the insurance carrier and claims are paid correctly.
- Mail letters to customers requesting missing information to complete order according to HIPPA and Medicare regulation.
- Perform mathematical calculations for submitting insurance claims including deductible amounts, allow amounts, secondary insurance allow amounts and patients responsibility.
- Used knowledge about prior authorization processes for private insurance carriers and state Medicaid programs to ensure that beneficiaries receive eligible coverage.
- Handle various workman's compensation claims pertaining to DME.
Reimbursement specialist skills and personality traits
We calculated that 20% of Reimbursement Specialists are proficient in Patients, Customer Service, and Appeals. They’re also known for soft skills such as Analytical skills, Detail oriented, and Integrity.
We break down the percentage of Reimbursement Specialists that have these skills listed on their resume here:
- Patients, 20%
Perform mathematical calculations for submitting insurance claims including deductible amounts, allowed amounts, secondary insurance allowed amounts and patients responsibility.
- Customer Service, 9%
Facilitated in depth training of 30 customer service representatives that proactively resolved reimbursement escalations resulting in reduced time spent addressing inquiries.
- Appeals, 6%
Resolved errors by resubmitting corrected or unacknowledged claims, medical records, appeals and other documentation required for timely payments.
- CPT, 5%
Reconciled charges, daily coding audits and reimbursement analysis, coordination of master-file updates, fiscal year ICD-9 and CPT code updates
- Medicare, 4%
Prepared financial models to estimate effect of changes in Medicare reimbursement methodologies on revenues for HealthSouth hospitals.
- Medicaid, 4%
Used knowledge about prior authorization processes for private insurance carriers and state Medicaid programs to ensure that beneficiaries received eligible coverage.
Common skills that a reimbursement specialist uses to do their job include "patients," "customer service," and "appeals." You can find details on the most important reimbursement specialist responsibilities below.
Analytical skills. One of the key soft skills for a reimbursement specialist to have is analytical skills. You can see how this relates to what reimbursement specialists do because "health information technicians must understand and follow medical records and diagnoses, and then decide how best to code them in a patient’s medical records." Additionally, a reimbursement specialist resume shows how reimbursement specialists use analytical skills: "maintained hospital and ancillary contract parameters, fee schedule and demographic data. "
Detail oriented. Another essential skill to perform reimbursement specialist duties is detail oriented. Reimbursement specialists responsibilities require that "health information technicians must be accurate when recording and coding patient information." Reimbursement specialists also use detail oriented in their role according to a real resume snippet: "detail understanding and interpretation of explanation of benefit's (eob's). "
Integrity. Another skill that relates to the job responsibilities of reimbursement specialists is integrity. This skill is critical to many everyday reimbursement specialist duties, as "health information technicians work with patient data that are required, by law, to be kept confidential." This example from a resume shows how this skill is used: "maintained high level of integrity and confidentiality/patient privacy (hippa). "
Interpersonal skills. For certain reimbursement specialist responsibilities to be completed, the job requires competence in "interpersonal skills." The day-to-day duties of a reimbursement specialist rely on this skill, as "health information technicians need to be able to discuss patient information, discrepancies, and data requirements with other professionals such as physicians and finance personnel." For example, this snippet was taken directly from a resume about how this skill applies to what reimbursement specialists do: "cited for excellence in interpersonal communications, teamwork, customer service, flexibility and reliability. "
Technical skills. Another common skill required for reimbursement specialist responsibilities is "technical skills." This skill comes up in the duties of reimbursement specialists all the time, as "health information technicians must use coding and classification software and the electronic health record (ehr) system that their healthcare organization or physician practice has adopted." An excerpt from a real reimbursement specialist resume shows how this skill is central to what a reimbursement specialist does: "recognized for customer service expertise and technical skills. "
The three companies that hire the most reimbursement specialists are:
- Change Healthcare50 reimbursement specialists jobs
- Hackensack Meridian Health8 reimbursement specialists jobs
- Prime Healthcare7 reimbursement specialists jobs
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Compare different reimbursement specialists
Reimbursement specialist vs. Biller
Billers are medical professionals who are responsible for translating health care services into medical claims to be submitted to insurance companies. These billers are required to obtain patient medical records and interpret them to determine the billable units and services. They must manage all aspects of the medical billing process and make necessary contacts with insurance payers or patients to ensure maximum reimbursements. Billers must also provide services that are associated with internal and external customer billing and payment processing operations.
There are some key differences in the responsibilities of each position. For example, reimbursement specialist responsibilities require skills like "medicare," "medical terminology," "credit balances," and "mds." Meanwhile a typical biller has skills in areas such as "math," "icd-10," "dmv," and "insurance billing." This difference in skills reveals the differences in what each career does.
Billers tend to make the most money working in the manufacturing industry, where they earn an average salary of $42,377. In contrast, reimbursement specialists make the biggest average salary, $41,366, in the pharmaceutical industry.billers tend to reach similar levels of education than reimbursement specialists. In fact, billers are 2.3% less likely to graduate with a Master's Degree and 0.2% less likely to have a Doctoral Degree.Reimbursement specialist vs. Records coordinator
A records coordinator takes responsibility for doing administrative and clerical work. Records coordinators maintain the filing system of the central records. They monitor, post, and process university forms for personnel and budgetary actions. It is their job to maintain an organized central filing system. They must know the requirements applicable to their organization. There are certain skills every records coordinator should acquire. Some of them are skills in procurement management, organizational, negotiation, finance and accounting, and analytical.
Each career also uses different skills, according to real reimbursement specialist resumes. While reimbursement specialist responsibilities can utilize skills like "appeals," "cpt," "medicare," and "medical terminology," records coordinators use skills like "excellent organizational," "hard copy," "subpoenas," and "federal regulations."
Records coordinators earn a higher average salary than reimbursement specialists. But records coordinators earn the highest pay in the energy industry, with an average salary of $47,277. Additionally, reimbursement specialists earn the highest salaries in the pharmaceutical with average pay of $41,366 annually.records coordinators earn similar levels of education than reimbursement specialists in general. They're 2.8% more likely to graduate with a Master's Degree and 0.2% more likely to earn a Doctoral Degree.Reimbursement specialist vs. Medical records clerk
Medical records clerks are employees in hospitals or clinics who manage office records. They are in charge of creating, updating, and filing patient-related medical records and other related documents. They ensure that all documents are correctly filled out and labeled before storing them safely in their respective storage areas. They may also be in charge of digitizing forms for easier access to files and back up purposes. They ensure that medical records are exact and updated. Medical records clerks should be organized and must always be on top of all tasks related to patient or medical records.
There are many key differences between these two careers, including some of the skills required to perform responsibilities within each role. For example, a reimbursement specialist is likely to be skilled in "appeals," "medicare," "hcpcs," and "patient accounts," while a typical medical records clerk is skilled in "patient care," "basic math," "math," and "english language."
Medical records clerks make a very good living in the health care industry with an average annual salary of $32,510. On the other hand, reimbursement specialists are paid the highest salary in the pharmaceutical industry, with average annual pay of $41,366.When it comes to education, medical records clerks tend to earn similar degree levels compared to reimbursement specialists. In fact, they're 2.5% less likely to earn a Master's Degree, and 0.0% less likely to graduate with a Doctoral Degree.Reimbursement specialist vs. Medical records technician
A medical records technician is responsible for performing administrative duties, handling patients' medical records for medical purposes. Medical records technicians keep an organized database of patients' information, including medical history, diagnosis, healthcare treatments, laboratory schedules, and insurance details using specific healthcare coding procedures. Medical records technicians must be detail-oriented and highly organizational, especially on maintaining the accuracy and confidentiality of patients' information. This job is critical in the healthcare industry for the doctors' reference and determining treatment costs.
Even though a few skill sets overlap between reimbursement specialists and medical records technicians, there are some differences that are important to note. For one, a reimbursement specialist might have more use for skills like "appeals," "medicare," "patient accounts," and "home health." Meanwhile, some responsibilities of medical records technicians require skills like "patient care," "medical facilities," "medical charts," and "excellent interpersonal. "
The government industry tends to pay the highest salaries for medical records technicians, with average annual pay of $40,715. Comparatively, the highest reimbursement specialist annual salary comes from the pharmaceutical industry.In general, medical records technicians hold similar degree levels compared to reimbursement specialists. Medical records technicians are 1.9% less likely to earn their Master's Degree and 0.1% less likely to graduate with a Doctoral Degree.Types of reimbursement specialist
Updated January 8, 2025
