Medical Reimbursement Specialist
The Job Holder
San Diego medical billing organization is looking to add a talented Medical Reimbursement Specialist to their team.
The selected professional would be responsible for the following duties:
- Trend identification - identify consistent payer or system trends that result in underpayments, denials, errors, etc.
- Payer escalation - ability to understand and navigate payer guidelines; determine and escalate claim issues with payer when appropriate
- Trend escalation - meet with leadership to discuss/resolve reimbursement and/or payer obstacles
- Appeals - determine when an appeal, reopening, redetermination, etc. should be requested and the requirement of each insurance carrier; take appropriate action to resolve claim
- Claim status - use available resources such as payer portals and clearinghouses to review unresolved accounts
- Unapplied payments - identify unapplied payments and take appropriate action to resolve account
- Denial management - research and determine claim denials and take appropriate action for payment within federal, state, and payer guidelines
- Overpayment resolution - process or appeal refund requests following federal, state, and/or payer guidelines
- A minimum of 3 years of experience in a reimbursement role, handling high-volume workloads
- Experience in billing 1500 and UB04 claim forms
- Capable of working multiple claims at once
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