Account Reimbursement Specialist II

Account Reimbursement Specialist II

Job Summary: The Account Reimbursement Specialist II demonstrates a thorough understanding of medical office billing-related functions. This role will closely monitor and analyze payor denial trends, perform claim corrections, and perform timely claim follow-up by submitting appeals and claim reconsiderations to ensure maximum payor reimbursement. This role is vital to the overall financial success for the organization.

(This is a full-time position that will support RCM team Monday - Friday 8 am to 5 pm).

Primary Job Responsibilities:

• Ability to perform all responsibilities of ARS I position.
• Acts as point of contact for assigned department(s) for incoming questions regarding third-party billing requirements, denials, and patient-related billing inquiries.
• Coordinates with RCM team partners responsible for charge capture, coding, reimbursement and/or insurance verification to identify and resolve issues impacting billing and collections.
• Pursues timely collection of insurance claim payments using thorough follow-up efforts appropriate for each payor type (including denials, appeals, exceptions, exclusions).
• Review and interpret insurance explanation of benefits (EOBs) to ensure correct claim reconciliation.
• Filing appeals when appropriate to obtain maximum payor reimbursement.
• Analyzes trends in under/overpayments and payment denials and works collaboratively to develop process improvements meant to improve RCM operations and reduce costs.
• Coordinate medical records requests; process all insurance and patient correspondence to ensure compliance with all relative reporting and data collection regulations.
• Perform patient and insurance payor outreach to research and resolve payment-related inquiries for Athena patient cases.
• Work collaboratively with clinic managers and other RCM department staff to improve processes and procedures.
• Participate in department workgroups providing feedback and education on claims activities (payer denials, system issues, etc).
• Additional duties as assigned.

Requirements:

• Minimum of three (3) years of complex claim follow-up experience in a physician office, hospital, ambulatory surgery center or centralized medical business office.
• Knowledge of HMO/PPO, Medicare, Medicaid, and other payor regulations, payment guidelines, and policies.
• Knowledge of medical terminology, ICD-10, and CPT codes.
• Excellent verbal communication skills.
• Excellent computer skills; familiarity with Microsoft Word & Excel.
• Experience with AthenaHealth EMR is a plus.
• Ability to manage time and organize daily schedule to meet productivity and accuracy standards.
• Experience interpreting payor explanation of benefits.
• Excellent verbal communication skills and strong customer-service background.

Education and Certifications

• High school diploma or equivalent required.
• Associate degree in business, healthcare administration or related field highly preferred.

Physical Requirements

• Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
• Must be able to lift and support weight of 35 pounds.
• Ability to concentrate on details.
• Use of computer for long periods of time.