Account Reimbursement Specialist II

tryonmedicalpartners; Charlotte (NC); On-site; USD 52,000 - 70,000; Full time

Job summary

Tryon Medical Partners in Charlotte, NC is seeking a Revenue Cycle Account Reimbursement Specialist II to process and optimize billing for office and hospital procedures. You will ensure accurate claim data entry, verify patient eligibility, and monitor payer responses to improve reimbursement and cash flow.

This is a full-time on-site role supporting the RCM team Monday through Friday, 8 am to 5 pm. Ideal candidates have at least two years in complex claim follow-up, knowledge of ICD-10/CPT

Qualifications

• Two or more years of complex claim follow-up in healthcare settings.
• Knowledge of medical terminology, ICD-10, and CPT codes.
• Strong computer skills; proficient in Word, Outlook, and Excel.
• Experience with EMR systems; AthenaHealth EMR a plus.
• Experience interpreting payor explanations of benefits.
• Excellent verbal communication and customer-service skills.
• Ability to manage time and organize daily schedule to meet productivity targets.
• High school diploma or equivalent; associate degree preferred.

Responsibilities

• Performs daily billing activities to ensure successful processing and payment of claims.
• Ensures claim information is complete and accurate for charge entry and data entry of demographic information.
• Verifies patient benefits, eligibility, and coverage for accurate billing.
• Audits completeness and accuracy of all claims prior to submission.
• Make necessary claim corrections to resolve payer edits and rejections.
• Reports billing changes and process improvements to RCM Leadership.
• Resolves patient cases via phone or written communication, processes virtual payments, refund requests, bankruptcies, and reconciliations.
• Ensures HIPAA compliance.
• Performs other duties within scope of responsibility.

Skills

Complex claim follow-up

ICD-10/CPT knowledge

MS Office Proficiency

EMR systems experience

AthenaHealth EMR experience

Payor benefits interpretation

Verbal communication

Time management

Education

High school diploma or equivalent

Associate degree in healthcare administration or related field (preferred)

Tools

AthenaHealth EMR

Microsoft Excel

Job description

Revenue Cycle Account Reimbursement Specialist II

Job Summary:

The Account Reimbursement Specialist I (ARS I) is responsible for accurately processing information to ensure accurate and compliant billing for office and hospital procedures. The Revenue Cycle – ARS I researches insurance guidelines and focuses on improving the effectiveness of billing processes. The position requires attention to detail, strong organizational skills, and dependability. This role is vital to the overall financial success for the organization. This is a full time position that will support our RCM team at SouthPark Monday to Friday, 8 am to 5 pm

Primary Job Responsibilities:

• Performs daily billing activities to ensure successful processing and payment of claims.
• Ensures claim information is complete and accurate for charge entry and data enters key demographic information necessary for insurance claim processing.
• Verifies all patient benefits, eligibility, and coverage to ensure accurate billing.
• Audits completeness and accuracy of all claims prior to submission to claims clearinghouse.
• Make necessary claim corrections to resolve payer claim edits and rejections.
• Reports billing changes, billing issues, and process improvement plan accomplishments to RCM Leadership.
• Completes tasks in RCM to resolve patient cases (via phone or written communication), process virtual payments, process insurance refund requests, research missing payments, process bankruptcy and deceased patient notifications, and collection account reconciliation.
• Ensures compliance with all Health Insurance Portability and Accountability Act (HIPAA) standards.
• Performs other duties as required or assigned within the scope of responsibility.

Requirements:

• Minimum of two (2) years of complex claim follow-up experience in a physician office, hospital, ambulatory surgery center or centralized medical business office.
• Knowledge of medical terminology, ICD-10, and CPT codes.
• Excellent computer skills; Intermediate skill with Microsoft Word, Outlook, and Excel.

• Experience working within EMR systems.
• Experience with AthenaHealth EMR is a plus.

• Experience interpreting payor explanation of benefits.
• Excellent verbal communication skills and strong customer-service background.
• Ability to manage time and organize daily schedule to meet productivity and accuracy standards.

Education and Certifications:

• High school diploma or equivalent required.
• Associate degree in business, healthcare administration or related field highly preferred.

Physical Requirements:

• Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling.
• Must be able to lift and support weight of 35 pounds.
• Ability to concentrate on details.
• Use of computer for long periods of time.