Schedule: Mon-Fri 9am-5pm
Salary: $25.00-$26.50 / hour (DOE)
The Reimbursement & Billing Specialist is coordinates the analysis and effective resolution of denied claims with the purpose of reducing overall denials and increasing revenue. The Reimbursement & Billing Specialist is responsible for prioritizing and managing to resolution denied claims with government and third party payers.
Responsibilities include:
- Interpreting payment and denial data down to the line item detail
- identifying payer and coding trends, risks, and opportunities, and to implement operational and/or systematic improvements.
- Researches, develops, and maintains a solid understanding of payer requirements, including filing limit, claim processing logic, coordination of benefits requirements, patient responsibility and authorization requirements.
- Triages denied claims to identify appropriate action to ensure timely processing and payment.
- Performs ongoing analysis to determine the root cause of denials and proactively alert management to issues and trends.
- Proactively makes recommendations for workflow, operational, and/or systemic changes to reduce denials and speed up collections.
- Assists in developing and modifying tracking and reporting process for denials, appeals status and appeals results. Ensures that all denials are tracked and the appeals are monitored accordingly.
- Performs other duties as required.