Accounts Receivable Reimbursement Specialist
Orthopaedic Specialty Group
- Shelton, CT
- $19.00-22.00 per hour
- Permanent
- Full-time
- High school diploma required
- College education or trade school preferred
- Certified Professional Coding certification helpful
- Minimum 1 year experience working in a physician group practice billing department
- Working knowledge of CPT and ICD10-CM coding for Orthopaedic surgery
- Comfortable using email and interacting with Internet applications
- Experience with EMR, PM system, and word processing software
- Able to establish good relationships with insurance companies
- Good analytical skills and an affinity for detail
- Ability to read and analyze accounts receivable and payor reports
- Pleasant speaking voice and demeanor
- Neat, professional appearance
- Strong written and verbal communication skills
- Follows up on rejected claims the day that the rejected EOB is received
- Using data from the monthly aged accounts receivable report, calls payors or looks up claims status online to inquire about unpaid insurance claims that are 45 days old; records response or activity in the computer system "notes"
- Makes necessary arrangements for medical records requests, completion of additional paperwork, etc., if payors request this information prior to payment of claims
- Responds to written and telephone inquiries from insurance companies
- Manages relationships with personnel from assigned carriers
- Calls carriers to appeal payments that do not match contractual agreement; notifies Manager of payors for which this is a consistent problem
- Asks physicians or CPCs to provide appeal language for denials, or to support medical necessity
- Processes requests for refunds, and submits to Director of Revenue Cycle Management for approval
- Meets with Accounts Receivable Team regularly to discuss and solve reimbursement and insurance follow up problems
- Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the practice
- Attends regular staff meetings as requested
- Attends continuing education sessions as requested
- Performs any additional duties as required by the Billing Department