Reimbursement Specialist at Illinois Bone and Joint Institute LLC

Park Ridge, Illinois, United States -

Full Time

Start Date

Immediate

Expiry Date

19 Jun, 26

Salary

27.0

Posted On

21 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Accounts Receivable Knowledge, EOB Analysis, HIPAA Compliance, Medicare Knowledge, Medicaid Knowledge, HMO Knowledge, PPO Knowledge, EPO Knowledge, Work Comp Knowledge, Commercial Insurance Knowledge, Problem-Solving, Detail Oriented, Organizational Skills, Claim Denial Resubmission, Appeals Management, Contract Rate Analysis

Industry

Hospitals and Health Care

Description

Description Summary The Revenue Reimbursement Specialist works to ensure that we are optimizing insurance collections, reducing outstanding balances, and maintaining the accounts receivables. Revenue Reimbursement Specialists will maximize reimbursement for all services while minimizing the amount of time it takes to obtain reimbursement; decrease AR sustain a low DSO. Responsibilities Communicate directly with the payor, resubmits denied claims, underpaid claims and claims that are inaccurately processed by auditing accounts to check on proper payments, coding, balances, adjustments, etc. using appropriate reports and queues Review and analyze claim denials in order to perform the appropriate appeals necessary for reimbursement Manage outstanding accounts receivable for assigned payers/Divisions. Resolve outstanding balances. Follow up on outstanding accounts receivables, 31-60 days, 61-90 days. Includes researching aged account reports, outstanding “list”, processing problematic EOB’s and/or incoming mail or correspondence as identified. Special projects on 90+ days detailing problematic accounts and reporting them to the supervisor. Identify errors, correct and communicate to management Additional Responsibilities: Conduct random audits to verify system integrity, payer accuracy and payment per contract, to optimize reimbursement functions. Other duties as assigned Focus may be on claims or charges not paid at the correct contract rate. Requirements Skills and Competencies Accounts Receivable knowledge: ability to read, analyze and interpret EOB’s and other AR procedures Adheres to organizational policies and procedures, including Corporate Compliance Program, HIPAA regulations. Knowledge of Medicare, Medicaid, HMO/PPO/EPO, Work Comp and Commercial Insurance operating procedures Ability to effectively correspond and interact with insurance payers, co-workers, management both verbally and in writing. Detail Oriented with organizational and problem-solving skills. The ability to work in a fast-paced environment Requirements/Qualifications High School Graduate Minimum 2 years’ experience in Healthcare Revenue Cycle Strong problem-solving skills and the ability to make timely decisions Knowledge of Federal, State and third-party payor reimbursement rules and regulations Certified Coder preferred, but not required This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve. Salary is commensurate with experience, skills and qualifications. Base salary offers for this position may vary based on factors such as location, skills and relevant experience. We offer the following benefits to those who are benefit eligible (30+ hours a week): medical, dental, vision, life and AD&D insurance, long and short term disability, 401k program with company match and profit sharing, wellness program, health savings accounts, flexible savings accounts, ID protection plan and accident, critical illness and hospital benefits. In addition, we offer paid holidays and paid time off.

Responsibilities

The specialist is responsible for optimizing insurance collections, reducing outstanding balances, and managing accounts receivable by communicating with payors, resubmitting denied claims, and performing necessary appeals. This includes resolving outstanding balances for assigned payers by following up on aged accounts and processing problematic Explanation of Benefits (EOBs).