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Skills
Accounts Receivableunmatched
Billingunmatched
Case Managementunmatched
Claims Processingunmatched
Communication Skillsunmatched
Corporate Policiesunmatched
Current Procedural Terminology (CPT)unmatched
Customer Support/Serviceunmatched
Data Analysisunmatched
Demographicsunmatched
Detail Orientedunmatched
Documentationunmatched
Governmentunmatched
Healthcare Common Procedure Coding System (HCPCS)unmatched
ICD-10unmatched
ICD-9unmatched
Insuranceunmatched
Interpersonal Skillsunmatched
Mathematicsunmatched
Medical Billingunmatched
Medical Officeunmatched
Medical Recordsunmatched
Microsoft Excelunmatched
Microsoft Outlookunmatched
Microsoft Wordunmatched
Negotiation Skillsunmatched
Organizational Skillsunmatched
Payment Postingunmatched
Pharmacyunmatched
Presentation/Verbal Skillsunmatched
Pricingunmatched
Problem Solving Skillsunmatched
Product/Service Launchunmatched
Public/Media/Press/Analyst Relationsunmatched
Reimbursementunmatched
Standard Operating Procedures (SOP)unmatched
Standards Developmentunmatched
Time Managementunmatched
Trend Analysisunmatched
Writing Skillsunmatched
Description
Reimbursement Coordinator
San Bruno, CA
$19.50/HR
Hours: 7:00 AM - 4:00 PM Monday - Friday
POSITION SUMMARY:
Under the general supervision of the Reimbursement Supervisor / Manager, is responsible for various reimbursement functions, including but not limited to accurate and timely claim submission, claim status, collection activity, appeals, payment posting, and/or refunds, until accounts receivable issues are properly resolved.
PRIMARY DUTIES AND RESPONSIBILITIES:
Completing/Conducting Benefit Investigations
Completing Prior Authorizations and determining best approach for a PA process
Transferring Cases to Specialty Pharmacies
Follow-up Calls to Insurances
Conducting Alternative Coverage searches
Creating letters of medical necessity
Drafting appeal letters
Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program
Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications
Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payors. Researches and resolves any electronic claim denials
Researches and resolves any claim denials or underpayment of claims
Effectively utilizes various means for collections, including but not limited to phone, fax, mail, and online methods
Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly
Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers
Reports any reimbursement trends/delays to supervisor (e.g. billing denials, claim denials, pricing errors, payments, etc.)
Processes any necessary insurance/patient correspondence
Provides all necessary documentation required to expedite payments. This includes demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians
Coordinates with inter-departmental associates to obtain appropriate medical records as they relate to the reimbursement process
Maintains confidentiality in regards to patient account status and the financial affairs of clinic/corporation
Communicates effectively to payors and/or claims clearinghouse to ensure accurate and timely electronically filed claims
Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action
Typically receives little instruction on day-to-day work, general instructions on new assignments
Performs related duties as assigned
MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:
Must have recently experience with Health Insurance
Ability to communicate effectively both orally and in writing
Ability to build productive internal/external working relationships
Strong interpersonal skills
Strong negotiating skills
Strong mathematical skills
Strong organizational skills; attention to detail
General knowledge of accounting principles, pharmacy operations, and medical claims
General knowledge of HCPCS, CPT, ICD-9 and ICD-10 coding preferred
Global understanding of commercial and government payers preferred
Ability to proficiently use Microsoft Excel, Outlook and Word
Is developing professional expertise; applies company policies and procedures to resolve a variety of issues