Reimbursement Specialist

Automatic Data Processing, Inc.; Birmingham (AL); On-site; USD 38,000 - 62,000; Full time

Job summary

Automatic Data Processing, Inc. seeks a Reimbursement Specialist in Birmingham, AL to monitor and resolve patient accounts and maximize financial responsibility for patients. You will build relationships with patients and guarantors, handle eligibility, benefits inquiries, and non-covered services.

You will collect co-pays and coinsurance, document interactions in the EMR, and collaborate with Intake and Sales to resolve complex issues while maintaining accuracy and timely follow-up.

Qualifications

• 2+ years in healthcare reimbursement, with focus on insurance verification, billing and collections.
• Exceptional communication skills (verbal and written).
• Strong interpersonal skills.
• Excellent organizational and process skills.
• Ability to work under pressure and meet deadlines.
• Strong problem-solving and critical thinking abilities.
• Proven performance and track record in related field.
• Attention to detail and demonstrated results.
• Customer satisfaction focus.

Responsibilities

• Informs patient of coverage and financial responsibility.
• Creates Insurance Benefit Summary documents as needed.
• Collects co-pays, deductibles, and coinsurance prior to services.
• Collects payment from self-pay patients for non-covered services.
• Documents all patient interaction in EMR as a billing note.
• Resolves complex inquiries or issues relating to patient accounts.
• Manages patient pay AR accounts per established guidelines.
• Ensures patient pay accounts are current.
• Serves as resource for patients, Intake and Sales.
• Receives patient pay complaints and provides solutions.
• As needed, verifies insurance coverage and eligibility through payor websites; documents findings.
• Assists with Ready To Bill (RTB).
• Performs other duties, special projects as assigned.

Skills

Healthcare Reimbursement

Insurance Verification

Billing & Collections

Communication Skills

Organizational Skills

Problem Solving

Attention to Detail

Customer Service

Tools

EMR

Job description

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
• 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
• 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.