Job Description
Job Summary:The Reimbursement Specialist role is responsible for monitoring and resolving patient accounts to ensure patient financial responsibility or out-of-pocket monies are collected.This role will develop and create relationships with the patient or guarantor, to assist with all financial inquiries, explanation of benefits and non-covered services.Roles and Responsibilities:Informs patient of home health/home infusion coverage and as appropriate, financial responsibility Creates Insurance Benefit Summary (IBS) documents as needed Collects out-of-pocket co-pays, deductibles, and co-insurance prior to services rendered in accordance with the insurance eligibility/coverage information provided by payor at time of insurance verification Collects payment from self-pay patients for non-covered services Processes patient-pay payments Documents all patient interaction in EMR as a billing note Resolves complicated inquiries or issues relating to patient accounts, to include screening for financial hardship and patient responsibility Manages, monitors, and reviews patient pay AR accounts according to established guidelines Ensures patient pay accounts are current Serves as a resource and problem resolution expert for patients, Intake and Sales Receives patient pay complaints and provides appropriate solutions, follow-up to ensure resolution As needed, verifies insurance coverage and eligibility through payor websites, E1 check, or by calling the payor directly.Documents information into EMR and communicates as appropriate to team members.Assists with Ready To Bill (RTB) as appropriate Performs other duties, special projects as assigned Qualifications and Experience:Required:2 or more years of experience in healthcare, reimbursement with focus on insurance verification, billing and collection functions Strong computer skills (Microsoft Word, Excel, PowerPoint) Exceptional communication - verbal and written Exceptional interpersonal skills Exceptional organizational and process skills Ability to work well under pressure, meet timelines, and completes assigned projects.Exceptional critical thinking and problem solving skills Proven performance, history in related field Exceptional attention to detail and demonstrated results Exceptional track record of customer satisfaction Preferred Experience with coordination of benefits, including but not limited to patient pay, HMO, PPO, TPA, state and federal payors.Prior work in specialty or home infusion, homecare or related field..