Remote Medical Insurance Reimbursement Specialist - Managed Medicaid

This is a remote position. This is for the Managed Medicaid team.

Summary: The Insurance Reimbursement Specialist, under the direction of Accounts Receivable Manager, ensures claims submitted to responsible entities are received, processed, and resolved in a timely manner. This position’s goals are met through professional communication, confidentiality and adherence to HIPAA guidelines, and a working knowledge of CMS/other payer guidelines.

Essential Duties and Responsibilities: (List in order of importance or percentage of time spent on the particular responsibility. High to Low)

1. Uses various methods (phone, web, fax, e-mail) of contacting insurance payers and/or responsible entities to obtain claim status on submitted and unresolved claims. (40%)
2. Research patient accounts to ensure account integrity, using all available resources and tools (i.e., payer websites, contracts, and internal references). Use critical thinking skills to resolve account denials and payer barriers.  (25%)
3. Take appropriate actions toward account resolution and appropriate balance. This may include actions such as facilitating interdepartmental communication, posting adjustment requests, and providing requested information to insurance payers and/or responsible entities. (20%)
4. Utilize internal computer systems and applications to thoroughly and professionally document all actions taken to reach resolution on an account.  (10%)
5. Communicate daily with management about payer trends identified. (5%)

Qualifications:

Required Education:  High school diploma or equivalent

Required Experience: 1 year of experience in healthcare revenue cycle or business office.

Required License/Registration/Certification:  None

Reasoning Ability: 

Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables.  Use reasoning to meet and maintain department and personal benchmarks.

Computer Skills: 

To perform this job successfully, an individual should have knowledge of Word Processing software, spreadsheet software and database software.

Physical Demands: 

In order to successfully perform this job, with or without a reasonable accommodation, the following are outlined below:  

The Employee is required to read, review, prepare and analyze written data and figures, using a pc or similar and should possess visual acuity.

The Employee may be required to occasionally climb, push, stand, walk, reach, grasp, kneel, stoop, and/or perform repetitive motions.

The Employee is not substantially exposed to adverse environmental conditions and therefore job functions are typically performed under conditions such as those found in general office or administrative work.