Reimbursement Counselor

Monroeville, PA

Post Date: 06/19/2017 Job ID: 22404 Category: Professional

  • 8am-5pm

  • 8: 30am-5: 30pm

Job Description:
  • The Reimbursement Counselor will be conducting benefit investigations.
  • Ideal candidate would be someone that has recent experience working in a Doctor s office working with Health Insurance companies.

  • 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.
  • 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.

  • 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.

  • Must have recent Health Insurance background.
  • Must be proficient in Word and Excel.
  • Will be contacting insurance plans to verify patient coverage and benefits.
  • Must have strong organization skills.
  • Must be detailed.
  • Excellent Communication Skills.
  • Heavy Phones and interaction.
  • Excellent Customer Service Skills.

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