The Medical Reimbursement Specialist monitors and analyzes payments to identify contractual variances, underpayments and overpayments, and denials. This position is responsible for appeals to third party payors to ensure the health system receives appropriate reimbursement for services provided.
Medical Reimbursement Specialist Duties and Responsibilities
- Identifies variances that are due to inappropriate auto proration; reports to leadership for timely correction
- Reviews and analyzes the reasons for variance using daily reports and tools. Variances include underpayments, overpayments and denials
- Corrects manual or missing proration as per contract or explanation of benefits
- Identifies inappropriate/denied payments based on health system payor contracts
- Initiates appeal letters or phone calls to all third party payors
- Prioritizes appeal requests based on contractual appeal timeframes and Account Receivable dollars.
Medical Reimbursement Specialist Qualification and Requirements
- High School diploma or equivalent is required
- Minimum (3) three years combined experience as an insurance collector, denials specialist or credit specialist in a hospital business office or insurance industry environment; or one year of experience in contracting underpayments or appeal processing is required
- Working knowledge of Managed Care contract administration and payor requirements required
- Experience and knowledge of patient accounting systems and Managed Care reimbursement applications in a multi-facility environment required
- Working knowledge of Microsoft Office applications
If you are interested in this Medical Reimbursement Specialist role and qualify please apply!
Project Manager - Healthcare Revenue Cycle
Keywords and Related Terms: Medicare, Medicaid, remittance, a/r, aging, payment, payment plans, charity, follow up, claims, rebill, medical biller, medical collector, financial counselor, patient registration, charity, payment plan, billing , collections , claims , follow-up , eob , patient , remittance , payor , insurance , review , submit , compliance , discrepancies
LaSalle Network is an Equal Opportunity Employer, m/f/d/v.
LaSalle Network is Chicago's leading provider of professional staffing and recruiting services. Specializing in accounting and finance, administrative, executive search, technology, marketing, call center, and human resources, LaSalle serves companies of all sizes and across all industries. Since inception in 1998, LaSalle Network has served over 2,500 clients and placed over 25,000 candidates in temporary, temporary to permanent, and permanent positions