FT, Monday-Friday 8:00-4:30
We re searching for a Reimbursement Representative to perform patient account receivable functions including claim submission, follow-up and collection in a timely and accurate manner.
- Validates the accuracy of all billed charges and of all new patient reimbursement files including complete patient, responsible party and insurance information by reviewing the order edit and billing edit lists and noting any necessary changes, fixes or additions.
- Recognizes potential reimbursement issues as they arise and communicates status of issues with the Billing Lead.
- Makes individual patient account receivable recommendations as necessary and communicates the information to the Billing Lead.
- Prepare, format and mail all insurance claims according to specific contract/payer requirements.
- Remains knowledgeable of third-party payer contracts, federal and state medical coverage programs and requirements as well as being knowledgeable on HIPAA regulations and guidelines.
- Completes claim follow-up calls on claims 30 days outstanding from the submission date.
- Receives and verifies all payments, adjustments, and patient balances to ensure receipt of proper payment according to contractual allowable. Records any necessary adjustments.
- Performs claim appeal functions upon receipt of EOB s. Follows-up on outstanding claims with insurance carrier and patient for status including processing correspondence, resubmitted denied claims and claims that are inaccurately processed.
- Process all account refunds within 30 days of identification.
- Coordinates with Payment Posting to determine which accounts will receive final notices. Monitors collection activity
- Determine which accounts will be forwarded to the collection agency.
- Monitors collection activity on self-pay balances in an organized and timely manner. Reviews accounts prior to sending to collection for possible charity care.
- Responds to inquiries from parents and third party payers in a professional manner that demonstrates and supports good relations between Children s Home Healthcare, the contracted providers, and the community.
- Review Account Receivable aging report and perform follow-up as required for aged amounts outstanding.
- Review and mail monthly billing statements.
- Serves as backup to the receptionist.
KNOWLEDGE, SKILLS AND ABILITIES
- Knowledge of the current healthcare climate, including current coding practices in regards to billing and processing of Explanation Of Benefit, managed care contracts, HIPAA standards and governmental program regulations.
- Ability to communicate effectively both verbally and in writing.
- The ability to use computers and 10 key adding machine, fax machine and copier.
- Must have the ability to work independently to effectively and efficiently perform assigned duties.
EDUCATION AND EXPERIENCE
- High school diploma or GED required.
- Minimum 1 year experience with medical insurance plans and types of benefit coverage required.
- Experience working with ICD-10, CPT and HCPC coding preferred
- Experience with universal billing forms such as UB04 and HCFA 1500 preferred.
Children's Hospital & Medical Center - Omaha