Reimbursement Processor

Location: Fort Mill, South Carolina
Posted On: 10/5/2017
Job Code: 4507-Reimbursement P
Job Description
Job Description
• Responsible for various reimbursement functions, including but not limited to accurate and timely claim submission, claim status, collection activity, appeals, payment posting, and/or refunds, until accounts receivable issues are properly resolved.
• Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program.
• Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications.
• Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payors. Researches and resolves any electronic claim denials. Researches and resolves any claim denials or underpayment of claims.
• Effectively utilizes various means for collections, including but not limited to phone, fax, mail, and online methods.
• Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
• Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers. Reports any reimbursement trends/delays to supervisor (e.g. billing denials, claim denials, pricing errors, payments, etc.)
• Processes any necessary insurance/patient correspondence.
• Provides all necessary documentation required to expedite payments. This includes demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians.
• Coordinates with inter-departmental associates to obtain appropriate medical records as they relate to the reimbursement process.
• Maintains confidentiality in regards to patient account status and the financial affairs of clinic/corporation. Communicates effectively to payors and/or claims clearinghouse to ensure accurate and timely electronically filed claims.
• Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action. Typically receives little instruction on day-to-day work, general instructions on new assignments. Performs related duties as assigned.
• Ability to communicate effectively both orally and in writing. Ability to build productive internal/external working relationships. Strong interpersonal skills. Strong negotiating skills. Strong mathematical skills. Strong organizational skills; attention to detail. General knowledge of accounting principles, pharmacy operations, and medical claims.
• General knowledge of HCPCS, CPT, ICD-9 and ICD-10 coding preferred. Global understanding of commercial and government payers preferred.
Category:IT  code:new
Job Requirements
• Ability to proficiently use Ms Excel, Outlook and Word. Is developing professional expertise; applies company policies and procedures to resolve a variety of issues.

• Experience 1 year of Accounting

• Clinical/Healthcare Knowledge

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Contact Details
Naina Khuraniya