Reimbursement Specialist

Job Description

Job Description

Job Summary:

The Reimbursement Specialist role is responsible for monitoring and resolving patient accounts to ensure patient financial responsibility or

out-of-pocket monies are collected. This role will develop and create relationships with the patient or guarantor, to assist with all financial inquiries,

explanation of benefits and non-covered services.

Roles and Responsibilities:

• Informs patient of home health/home infusion coverage and as appropriate, financial responsibility
• Creates Insurance Benefit Summary (IBS) documents as needed
• Collects out-of-pocket co-pays, deductibles, and co-insurance prior to services rendered in accordance with the insurance eligibility/coverage information provided by payor at time of insurance verification
• Collects payment from self-pay patients for non-covered services
• Processes patient-pay payments
• Documents all patient interaction in EMR as a billing note
• Resolves complicated inquiries or issues relating to patient accounts, to include screening for financial hardship and patient responsibility
• Manages, monitors, and reviews patient pay AR accounts according to established guidelines
• Ensures patient pay accounts are current
• Serves as a resource and problem resolution expert for patients, Intake and Sales
• Receives patient pay complaints and provides appropriate solutions, follow-up to ensure resolution
• As needed, verifies insurance coverage and eligibility through payor websites, E1 check, or by calling the payor directly. Documents information into EMR and communicates as appropriate to team members.
• Assists with Ready To Bill (RTB) as appropriate
• Performs other duties, special projects as assigned

Qualifications and Experience:

Required:

• 2 or more years of experience in healthcare, reimbursement with focus on insurance verification, billing and collection functions
• Strong computer skills (Microsoft Word, Excel, PowerPoint)
• Exceptional communication - verbal and written
• Exceptional interpersonal skills
• Exceptional organizational and process skills
• Ability to work well under pressure, meet timelines, and completes assigned projects.
• Exceptional critical thinking and problem solving skills
• Proven performance, history in related field
• Exceptional attention to detail and demonstrated results
• Exceptional track record of customer satisfaction

Preferred

• Experience with coordination of benefits, including but not limited to patient pay, HMO, PPO, TPA, state and federal payors.
• Prior work in specialty or home infusion, homecare or related field.