Medical Reimbursement Specialist

The Job Holder
San Diego, CA, USA
Apr 15, 2019

Client Name

Solomon Page

Requirements

Job Description

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

Qualifications:

  • 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