Reimbursement Representative

U.S. Renal Care; United States; Remote; USD 42,000 - 56,000; Full time

Benefits offered by this job

Medical / Pharmacy

Dental

Vision

401k with employer match

Voluntary benefits

PTO

Job summary

U.S. Renal Care is seeking a Reimbursement Representative to reconcile and review Medicare and Commercial patient balances in line with reimbursement policies.

The role handles EOBs/EOMBs, resolves claim rejections, and researches payer communications to ensure accurate payments. The ideal candidate has at least two years in health/medical billing, strong knowledge of CPT/ICD-9/HCPCS coding, HIPAA compliance, and proficiency with billing software and Microsoft Office.

Qualifications

• High School diploma or GED required.
• At least two years of experience in health/medical billing and collection.
• Proficient with computers and medical billing software.
• Advanced knowledge of CPT, ICD-9 and HCPCS coding and billing requirements.
• HIPAA confidentiality knowledge.

Responsibilities

• Reviews EOB/EOMB's for proper reimbursement.
• Resolves electronic claim rejections and EOB denials promptly.
• Reviews insurance correspondence and corrects to ensure claims payment.
• Follows up on unpaid balances and assists with AR aging reports.
• Contacts Medicare/Medicaid and Commercial payors for resolution.
• Performs claim appeals as required.
• Assists with credit balance resolution.
• Completes re-bill requests to facilitate timely payment.
• Follows up on unresolved balances including RTP's.
• Prepares adjustment and write-off requests.

Skills

Medical Billing

HIPAA Knowledge

Medical Terminology

Microsoft Office

Coding CPT/ICD-9/HCPCS

Communication

Education

High School diploma or GED

Tools

Microsoft Outlook

Excel

Job description

Responsibilities

USRC's greatest strength in being a leader in the dialysis industry is our ability to recognize and celebrate the differences in our diverse workforce. We strongly believe in recruiting top talent and creating a diverse and inclusive work climate and culture at all levels of our organization.

SUMMARY

The Reimbursement Representative performs reconciliation and review of all outstanding Medicare/Commercial patient balances in accordance with US Renal Care reimbursement policies and procedures.

Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.

• Reviews EOB/EOMB's for proper reimbursement.
• Resolves electronic claim rejections and Explanation of Benefits denials in a timely manner.
• Reviews and researches insurance correspondence and makes necessary corrections to ensure claims payment.
• Follows up on unpaid/unresolved account balances, including claims rejected electronically, EOB denial and working A/R aging reports as directed. Provides insurance carriers with requested information to facilitate payment.
• Regularly contacts Medicare, Medicaid and /or Commercial payors for resolution to claims not paid or claims not paid according to plan benefits.
• Performs claim appeals as required.
• Assists with credit balance resolution.
• Completes re-bill request as necessary to facilitate timely and proper claims payment.
• Follows up on unresolved account balances including RTP's.
• Prepares adjustment and write-off requests as necessary.
• Performs other duties and responsibilities as required or assigned.

Qualifications

Qualifications/Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

Requirements include:

• High School diploma or GED require
• At least two years of experience in a health/medical billing and collection office.
• Ability to use copier, fax machine, printer, calculator and multi-line telephone
• Must be proficient with computers with an understanding of medical billing software
• Advanced knowledge of medical terminology as well as knowledge of government and private insurer rules and regulations.
• Advanced knowledge of CPT, ICD-9 and HCPCS coding as well as in-depth knowledge of medical billing requirements
• Working knowledge of Microsoft Outlook, Word and Excel
• Ability to utilize the internet, specifically Medicare and Medicaid websites
• Maintain confidentiality in regard to HIPAA rules and regulations, as well as private company matters

Benefit Details

• Medical / Pharmacy
• Dental
• Vision
• Voluntary benefits
• 401k with employer match
• Virtual Care
• Life Insurance
• Voluntary Benefits
• PTO

All Part Time employees are eligible for the following benefits:

• 401k with employer match
• PTO

Company (Career Site Brand)

U.S. Renal Care