Job Description
Overview
The Spec II Reimbursement is responsible for collecting on all outstanding balances for a specific group of payors to ensure maximum reimbursement. This role involves more complex tasks including payor research, root cause analysis, and problem resolution resulting in increased revenue.
Responsibility
- Responsible for collecting on all outstanding balances for a specific group of payors to assure maximum reimbursement.
- Work aged accounts, process appeals and corrected claims, research and reconcile credit balance accounts, and process adjustments as needed.
- Interact with payers and management team to ensure timely collections of accounts.
- Demonstrate excellent performance by:
- Identifying and resolving AR related issues with sustained improvement in cash collections.
- Regularly demonstrating independent collection, problem identification, and resolution skills.
- Escalating and resolving issues with payor supervisors, managers, and provider relations.
- Participating in team meetings and collaborating with Reimbursement Specialists across the enterprise to replicate payor best practices.
- Comply with applicable CLIA, HIPAA, and Compliance standards.
Qualifications
- High school diploma or GED equivalent required.
- 3+ years of experience working in medical billing or revenue cycle.
- Proven track record of high performance.
- Excellent organizational, communication, multitasking, and teamwork skills.
- Regularly demonstrate independent collection problem identification and resolution skills.
- Demonstrate ability to escalate and resolve issues with payor supervisors, managers, and provider relations.
- Display exemplary teamwork, professionalism, and time management.
- Ability to stay updated on industry trends, regulatory changes, and best practices in medical billing and reimbursement.
- Proficiency in medical billing software and electronic health records (EHR) systems.
- Working knowledge of ICD-10 and CPT codes.
no degree needed
