Reimbursement Analyst
Hughston
full-time
Posted on:
Location Type: Office
Location: Columbus • United States
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About the role
- Organize clinic claims for electronic or hard copy fax/mail and ensure receipt by appropriate third-party payors
- Review claims to ensure payor specific billing requirements are met
- Maintain active follow-up of outstanding accounts receivable
- Determine and apply appropriate adjustments
- Manage assigned accounts receivable as assigned to meet or exceed individual and departmental goals
- Review clinical documentation detail to ensure correct billing of procedures
- Appeal and/or dispute denials and underpayments when appropriate
- Adhere to timely follow up requirements as outlined by payor regulations for claims billing, resubmission and appeal
- Assist patients with questions/payments on their accounts, and update accounts when necessary
- Research and submit refunds for payment to meet regulatory requirements
- Establish/maintain relationships with office and clinical staff
- Obtain hospital authorizations when needed for claim billing
- Assist patients with the arrangement of payment plans for outstanding balances as outlined by clinic policies
- Collect monies owed by patients using third party software in accordance with all applicable third-party vendors, accounting and financial policies
- Ensure internal policies and procedures are adhered to by third-party outsourced vendors
- Process and post payments taken over the phone or virtually
- Maintain Unpostable Dashboard
- Educate assigned front desk staff regarding billing issues when identified
- Use of procedure ICD 10, CPT and Modifiers to meet compliance requirements and clean claim rates
- Navigation and use of payor sites functionality
- Determine eligibility/co-insurance/copayments and deductibles
- Complete HCFA 1500 as required by insurance payor policy requirement
- Complete accounts receivable follow-up exception reports
Requirements
- Preferred: Two (2) years of medical billing and/or collection experience
- Required: High School Diploma or equivalent
- Required: Proficient in front end (patient payments, demographic to file the claim) and back-office billing practices
- Required: Understanding of variances in state billing rules/requirements
- Required: Strong attention to detail
- Required: Strong drive to obtain all amounts owed to the organization
- Required: Ability to interpret payor explanation of benefits (EOB)
- Preferred: CPAR, CRCR, or equivalent
Benefits
- Candidates who are hired are eligible to receive a Healthcare Financial Management Association (HFMA) membership and access to certification trainings
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
medical billingaccounts receivableICD 10CPTHCFA 1500billing practicesclaims processingpayment postingadjustmentsrefund processing
Soft Skills
attention to detailcommunicationrelationship managementproblem-solvingorganizational skillsdrive for resultscustomer serviceteam collaborationeducational skillsfollow-up
Certifications
CPARCRCR