Revenue Cycle Reimbursement Specialist

The successful candidate will be a rockstar in the health plan prior authorization management and processing. While working with our Reimbursement, Commercial, and Finance teams this role will provide on-going insight and analytics of the medical billing and reimbursement cycle.

*This is a full time, non-exempt role with a schedule of Monday through Friday, 7:30am-4pm PST.

Responsibilities include:

• Verifying insurance/recipient eligibility, billing and follow-up on claims to Medicare, Medicaid and Private Insurer Payers.
• Researching and responding to Medicare, Medicaid and other Payer inquiries regarding billing issues and insurance updates.
• Reviewing unpaid and/or denied claims, appeals and follow-up on accounts to zero status.
• Organizing and distribute comprehensive appeal packages to the insurance provider.
• Ability to review and interpret explanation of benefits to determine contractual allowance.
• Researching accounts and resolving deficiencies.
• Calling insurance companies regarding outstanding accounts. Utilize payor websites to check claim status.
• Reviewing and submitting accurate claims, re-submissions and claim review forms.
• Researching and monitoring specific billing issues, trends and potential risks based on current research and customer feedback.
• Answering all patient/doctor/hospital/lab/insurance company phone calls regarding accounts, and takes appropriate action.
• Providing administrative support (when requested) including performing data entry, updating various record keeping systems, upholding company policies and Client requirements, and participating in projects, duties, and other administrative tasks.
• Knowledge, understanding, and compliance with all applicable Federal and Local laws and regulations relating to job duties.
• Knowledge, understanding, and compliance with Company policies and procedures.
• Other duties as assigned.

Who You Are:

• A university degree or a Certified Professional Coder or 2 yr Degree from Accredited Medical Billing School
• 1-2 Years of direct appeals and billing experience
• Enthusiasm and an entrepreneurial spirit
• Familiarity with ICD and HCPC/CPT coding preferred
• Familiarity with CMS 1500 claim form preferred
• Familiarity with Claim Adjustment Reason Codes (NUCC) preferred
• Use of personal computer, computer applications, and general office equipment including scanners.
• Ability to create and maintain spreadsheets
• Ability to use analytical, interpersonal, communication, organizational, numerical, and time management skills.
• Experience handling and expediting escalated issues, with follow up to the customer.
• Ability to quickly assess a situation and take appropriate actions to address customer needs and requests in a timely and efficient manner. Self-starter with the ability to work independently and effectively in a team environment.
• Ability to organize and prioritize multiple projects/tasks and meet deadlines in a constantly evolving and fast-paced environment.
• Strong, consistent work ethic with a keen attention to details and ability to focus on the big picture.
• Excellent written and verbal communication skills.
• Must be able to communicate with confidence and tact across all levels within the company.

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