Reimbursement Specialist
- Charlotte, NC
- Permanent
- Full-time
- Researches and reviewed unpaid claims
- Understands how to bill a claim to Navicure as well as correct front end edits on Navicure
- Submits all payer refunds to management for review
- Understands voids and re-enters
- Requests coding changes
- Understands the contracted timely filing limits for claims based on carrier plan for all payers that CEMM contracts.
- Informs billing office staff of changes based on payer information received.
- Investigates patient eligibility and corrects as needed in the practice system
- Bills all insurance claims and statements
- Works insurance assigned AR
- Works payer denials
- Works Navicure edits and rejections
- Refiles accounts that may not have crossed over to the clearinghouse (Navicure)
- Answers patient billing calls and provides a status to the patients within 24 hours
- Researches account to provide the best possible outcome for the patient and CEMM.
- Works with insurance companies to provide missing documentation to ensure payment of claims.
- Maintains excellent rapport with insurance companies and representatives to assist with claims processing
- Understands how to read and interpret explanation of benefits, provides excellent customer service, accounts receivable follow up, obtains insurance authorizations, appeals denied claims.
- Past work with a claims clearinghouse is a plus.
- Medical billing certificates a plus, 2-3 years of insurance reimb experience a plus, experience with claim rejection and denials a plus.
- Must have a high school diploma or equivalent, have a basic understanding of medical terminology and insurance billing, 5 years' experience in a business office setting.
- Knowledge of Allscripts, Navicure. Understands how to interpret 835s and explanations of benefits. Accounts Receivable follow up, obtaining authorizations, appealing denied claims