Reimbursement Specialist

Reliable Medical; Tennessee; On-site; USD 42,000 - 56,000; Full time

Benefits offered by this job

Comprehensive Health Coverage

Generous Paid Time Off

Professional Development Opportunities

Retirement Savings Plan

Wellness Programs

Inclusive and Diverse Workplace

Volunteer Opportunities

Employee Recognition Programs

Parental and Childbirth Leave

Job summary

Reliable Medical is seeking a Reimbursement Specialist to ensure accurate reimbursement processes and compliance with insurance and regulatory guidelines. You will review claims, resolve billing discrepancies, and maintain HIPAA compliance, reporting to the Director of Reimbursement.

The role requires healthcare billing experience (2–3 years), knowledge of Brightree or similar systems, and strong attention to detail.

Qualifications

• High School Diploma or equivalent.
• A background in healthcare related industry experience required.
• Competent level of experience in medical billing (2-3 years minimum).
• Experience in Brightree and/or DME preferred.
• Must be knowledgeable of insurance requirements, policy guidelines, and have the ability to determine medical justification by reviewing documentation to ensure proper reimbursement.
• Ability to type over 30 WPM and navigate computer programs accurately and efficiently.
• Ability to effectively operate billing software and patient portal to cover the scope of his/her job description.

Responsibilities

• Assists in coordinating and maintaining the reimbursement program to ensure compliance with current payments, rules and legislative regulations that impact billing and collections.
• Monitors and evaluates current reimbursement/payment rules and policy guidelines to ensure that legislative and regulatory changes impacting medical billing are anticipated and communicated to the company.
• Ensures adherence to all HIPAA, JCAHO, and Compliance rules and regulations.
• Reviews authorization, detailed prescriptions, and verification for claims within his/her work group, to ensure that accurate claims were submitted for revenue and their medical necessity in the event the services were not paid accurately.
• Works towards minimizing AR within assigned workgroup by correcting and resubmitting claims, as well as submitting appeals.
• Communication with various insurance companies and payers to resolve billing and reimbursement discrepancies.
• Reviews information provided by payers regarding the reimbursement for goods and services, usually on an EOB or Remittance Advice, to ensure posting of payments align with these documents and reason for non-payment or inaccurate reimbursement.
• Trend identification should be performed through this process and escalated to management for global resolution.
• Confirms and prioritizes pick-ups, exchanges, and returns on both serialized and non-serialized equipment and supplies to ensure inventory and other functional operating areas are not negatively affected.
• Ensures that claims are followed up in a timely manner, specifically no longer than payer requirements, to avoid write-offs.
• Requesting adjustments, write-offs, or refunds from manager on balances over $1,000.00.
• Responds to customer inquiries both in person and telephonically as necessary, including but not limited to payments on account, questions about benefits, and questions about insurance policy.
• Prepares and submits medical records to the various payers on request to facilitate payment for services or audit.
• Meet or exceed KPIs and productivity in all measured areas.
• Performs other duties, as assigned by management.

Skills

Healthcare billing knowledge

Medical billing experience

Typing speed 30 WPM+

Microsoft Office proficient

Insurance knowledge

Education

High School Diploma or equivalent

Tools

Brightree

Billing software

Job description

Company Overview

Since our doors opened in 1989, Reliable Medical has been committed to improving the lives of all who entrust us with their care and those who we entrust to provide it. We strive to be the premier provider of complex mobility solutions and other critical services for customers seeking compassionate care and optimal outcomes. Our mission is to improve the lives of those we serve by providing best in class service to customers, education, product expertise and dedicated partnership to clinicians, and development, career satisfaction and work-life balance to our team members. We aspire to bring our mission to new communities and to reinvest our growth into improving lives, treating one another and our customers, like family.

Company Overview

Since our doors opened in 1989, Reliable Medical has been committed to improving the lives of all who entrust us with their care and those who we entrust to provide it. We strive to be the premier provider of complex mobility solutions and other critical services for customers seeking compassionate care and optimal outcomes. Our mission is to improve the lives of those we serve by providing best in class service to customers, education, product expertise and dedicated partnership to clinicians, and development, career satisfaction and work-life balance to our team members. We aspire to bring our mission to new communities and to reinvest our growth into improving lives, treating one another and our customers, like family.

Job Summary

The Reimbursement Specialist ensures accurate and compliant reimbursement processes, coordinating with insurance and regulatory guidelines. Reporting to the Director of Reimbursement and supervised by the Reimbursement Supervisor, responsibilities include reviewing claims, resolving billing discrepancies, and maintaining HIPAA and regulatory compliance. Ideal candidates have healthcare industry experience, proficiency in billing systems, and strong attention to detail.

Essential Functions

• Assists in coordinating and maintaining the reimbursement program to ensure compliance with current payments, rules and legislative regulations that impact billing and collections. Monitors and evaluates current reimbursement/payment rules and policy guidelines to ensure that legislative and regulatory changes impacting medical billing are anticipated and communicated to the company. Ensures adherence to all HIPAA, JCAHO, and Compliance rules and regulations.
• Reviews authorization, detailed prescriptions, and verification for claims within his/her work group, to ensure that accurate claims were submitted for revenue and their medical necessity in the event the services were not paid accurately.
• Works towards minimizing AR within assigned workgroup by correcting and resubmitting claims, as well as submitting appeals. Communication with various insurance companies and payers to resolve billing and reimbursement discrepancies.
• Reviews information provided by payers regarding the reimbursement for goods and services, usually on an Explanation of Benefits (EOB) or Remittance Advice, to ensure posting of payments align with these documents and reason for non-payment or inaccurate reimbursement. Trend identification should be performed through this process and escalated to management for global resolution.
• Confirms and prioritizes pick-ups, exchanges, and returns on both serialized and non-serialized equipment and supplies to ensure inventory and other functional operating areas are not negatively affected.
• Ensures that claims are followed up in a timely manner, specifically no longer than payer requirements, to avoid write-offs.
• Requesting adjustments, write-offs, or refunds from manager on balances over $1,000.00.
• Responds to customer inquiries both in person and telephonically as necessary, including but not limited to payments on account, questions about benefits, and questions about insurance policy.
• Prepares and submits medical records to the various payers on request to facilitate payment for services or audit.
• Meet or exceed Key Performance Indicators (KPIs) and productivity in all measured areas.
• Performs other duties, as assigned by management.

Qualifications And Requirements

• High School Diploma or equivalent.
• A background in healthcare related industry experience required.
• Competent level of experience in medical billing (2-3 years minimum).
• Experience in Brightree and/or DME preferred.
• Must be knowledgeable of insurance requirements, policy guidelines, and have the ability to determine medical justification by reviewing documentation to ensure proper reimbursement.
• Ability to type over 30 WPM and navigate computer programs accurately and efficiently.
• Ability to effectively operate billing software and patient portal to cover the scope of his/her job description.

Competencies

• Attention to Detail: Exhibits meticulousness and thoroughness in task completion.
• Integrity: Upholds honesty and ethical conduct in all actions.
• Cooperation: Maintains a positive and cooperative attitude while working with others.
• Effective Communication: Communicates effectively through both written and verbal means.
• Proficiency in Microsoft Office Suite: Demonstrates adeptness in using various Microsoft Office applications.

Our Commitment To You

• Comprehensive Health Coverage
• Generous Paid Time Off
• Professional Development Opportunities
• Retirement Savings Plan
• Wellness Programs
• Inclusive and Diverse Workplace
• Volunteer Opportunities
• Employee Recognition ProgramsService Awards
• Parental and Childbirth Leave

At Reliable Medical, we prioritize your well-being and growth, providing benefits that make your career journey both rewarding and fulfilling. Join us and experience the difference!

Reliable Medical is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, disability, age, veteran status, or other characteristics.