Sign upLog in
JobsJobs in CaliforniaJobs in San Bruno, CAHealthcare JobsMental Health Jobs

Reimbursement Counselor

MMC Group

San Bruno, CA

Apply
JOB DETAILS
SALARY
SKILLS
Accounts Receivable, Billing, Case Management, Claims Processing, Communication Skills, Corporate Policies, Current Procedural Terminology (CPT), Customer Support/Service, Data Analysis, Demographics, Detail Oriented, Documentation, Government, Healthcare Common Procedure Coding System (HCPCS), ICD-10, ICD-9, Insurance, Interpersonal Skills, Mathematics, Medical Billing, Medical Office, Medical Records, Microsoft Excel, Microsoft Outlook, Microsoft Word, Negotiation Skills, Organizational Skills, Payment Posting, Pharmacy, Presentation/Verbal Skills, Pricing, Problem Solving Skills, Product/Service Launch, Public/Media/Press/Analyst Relations, Reimbursement, Standard Operating Procedures (SOP), Standards Development, Time Management, Trend Analysis, Writing Skills
LOCATION
San Bruno, CA
POSTED
12 days ago
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:
  1. Completing/Conducting Benefit Investigations
  2. Completing Prior Authorizations and determining best approach for a PA process
  3. Transferring Cases to Specialty Pharmacies
  4. Follow-up Calls to Insurances
  5. Conducting Alternative Coverage searches
  6. Creating letters of medical necessity
  7. Drafting appeal letters
  8. Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program
  9. Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications
  10. 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
  11. Researches and resolves any claim denials or underpayment of claims
  12. Effectively utilizes various means for collections, including but not limited to phone, fax, mail, and online methods
  13. Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly
  14. Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers
  15. Reports any reimbursement trends/delays to supervisor (e.g. billing denials, claim denials, pricing errors, payments, etc.)
  16. Processes any necessary insurance/patient correspondence
  17. Provides all necessary documentation required to expedite payments. This includes demographic, authorization/referrals, National Provider Identification (NPI) number, and referring physicians
  18. Coordinates with inter-departmental associates to obtain appropriate medical records as they relate to the reimbursement process
  19. Maintains confidentiality in regards to patient account status and the financial affairs of clinic/corporation
  20. Communicates effectively to payors and/or claims clearinghouse to ensure accurate and timely electronically filed claims
  21. 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
  22. Typically receives little instruction on day-to-day work, general instructions on new assignments
  23. Performs related duties as assigned


MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS:
  1. Must have recently experience with Health Insurance
  2. Ability to communicate effectively both orally and in writing
  3. Ability to build productive internal/external working relationships
  4. Strong interpersonal skills
  5. Strong negotiating skills
  6. Strong mathematical skills
  7. Strong organizational skills; attention to detail
  8. General knowledge of accounting principles, pharmacy operations, and medical claims
  9. General knowledge of HCPCS, CPT, ICD-9 and ICD-10 coding preferred
  10. Global understanding of commercial and government payers preferred
  11. Ability to proficiently use Microsoft Excel, Outlook and Word
  12. Is developing professional expertise; applies company policies and procedures to resolve a variety of issues

About the Company

M

MMC Group

Resume Resources

Free Resume TemplatesFree Resume Builder

Similar Job Searches

Family Therapist Jobs in San Bruno, CAMental Health Therapist Jobs in San Bruno, CAPsychiatrist Jobs in San Bruno, CAPsychologist Jobs in San Bruno, CA