Reimbursement Representative

Job Description

Responsibilities

USRC's greatest strength in being a leader in the dialysis industry is our ability to recognize and celebrate the differences in our diverse workforce. We strongly believe in recruiting top talent and creating a diverse and inclusive work climate and culture at all levels of our organization.

SUMMARY

The Reimbursement Representative performs reconciliation and review of all outstanding Medicare/Commercial patient balances in accordance with US Renal Care reimbursement policies and procedures.

Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.

Reviews EOB/EOMB's for proper reimbursement.
Resolves electronic claim rejections and Explanation of Benefits denials in a timely manner.
Reviews and researches insurance correspondence and makes necessary corrections to ensure claims payment.
Follows up on unpaid/unresolved account balances, including claims rejected electronically, EOB denial and working A/R aging reports as directed. Provides insurance carriers with requested information to facilitate payment.
Regularly contacts Medicare, Medicaid and /or Commercial payors for resolution to claims not paid or claims not paid according to plan benefits.
Performs claim appeals as required.
Assists with credit balance resolution.
Completes re-bill request as necessary to facilitate timely and proper claims payment.
Follows up on unresolved account balances including RTP's.
Prepares adjustment and write-off requests as necessary.
Performs other duties and responsibilities as required or assigned.

Qualifications

Qualifications/Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

Requirements include:

High School diploma or GED require
At least two years of experience in a health/medical billing and collection office.
Ability to use copier, fax machine, printer, calculator and multi-line telephone
Must be proficient with computers with an understanding of medical billing software
Advanced knowledge of medical terminology as well as knowledge of government and private insurer rules and regulations.
Advanced knowledge of CPT, ICD-9 and HCPCS coding as well as in-depth knowledge of medical billing requirements
Working knowledge of Microsoft Outlook, Word and Excel
Ability to utilize the internet, specifically Medicare and Medicaid websites
Maintain confidentiality in regard to HIPAA rules and regulations, as well as private company matters