Revenue Cycle Reimbursement Specialist

Position Overview:
Reporting to the Director of Reimbursement, the Revenue Cycle Specialist is responsible for managing and resolving outstanding claims to achieve maximum reimbursement. This role requires strong knowledge of medical collections, accounts receivable, insurance billing and verification, denial management, appeal submission, and EOB review.

Responsibilities:  

·         Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.  

·         Manage daily work queue to prioritize high dollar claim balances.  

·         Review & work incoming insurance and patient correspondence including refund requests. 

·         Send appeals when appropriate or provide the requested medical documentation. 

·         Ability to review medical documentation to justify medical necessity.  

·         Review patient balances to ensure accuracy and follow up with patients to obtain payments.  

·         Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.  

·         Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.  

·         Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution. 

·         Negotiate payment amounts for procedures with Third Party Administrators for out of network providers. 

·         Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.  

Requirements: 

·         2+ years of ASC and/or orthopedic revenue cycle OR orthopedic collections experience. 

·         Ability to read and interpret insurance explanations of benefits and managed care contracts.  

·         Must communicate effectively, both verbally and in writing, with internal and external clients. 

·         Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines 

·         Knowledge or experience working with a variety of health care insurance payers is preferred 

·         Intermediate computer proficiency in Microsoft Office including Excel and Outlook 

·         Greenway Intergy, MedInformatix, and/or Nextgen Practice Management experience a plus but not required.

·         High School Diploma or equivalent.