Reimbursement Specialist II - Claims & Payor Expert

Alternate Solutions Health Network, LLC; Ohio; Hybrid; USD 40,000 - 60,000; Full time

Job summary

Alternate Solutions Health Network, LLC in Kettering, OH is seeking a Reimbursement Specialist to manage collections for assigned payors, verify eligibility, and ensure timely claim processing. The role supports patient satisfaction and quality outcomes while complying with Medicaid, private insurance rules and company policies.

Responsibilities include following up on accounts, resubmitting claims, advising on denial trends, assisting families with billing procedures, correcting and rebilling

Qualifications

• High school diploma or equivalent.
• An Associate’s degree or equivalent experience required.
• Billing and Health Care experience is required
• Excellent oral and written communication skills.
• Proficiency in Microsoft Excel, Word, and Outlook.
• Detail oriented with ability to manage multiple responsibilities and ability to prioritize responsibilities.

Responsibilities

• Collects and follows up on accounts for payment in full
• Sends all electronic and paper claim resubmissions or correct claims
• Makes recommendations to the Controller regarding difficult payors with regards to prompt payments, claims processing, and recognition of denial trends
• Assists clients, their families and co-workers in understanding billing procedures and payment
• Corrects claims and rebills for payment
• Communicates with employees, clients and vendors in regards to services
• Proactively addresses billing challenges
• Understands and practices agency policies and procedures
• Continually improves practices
• Follows all legal rules and regulations
• Attends in-services, educational programs and meetings as necessary
• Other duties as assigned

Skills

Billing experience

Healthcare experience

Communication skills

Office software

Detail oriented

Education

High school diploma or equivalent

Associate degree or equivalent experience

Tools

Microsoft Excel

Microsoft Word

Microsoft Outlook

Job description

Alternate Solutions Health Network, LLC in Kettering, OH is seeking a Reimbursement Specialist to manage collections for assigned payors, verify eligibility, and ensure timely claim processing. The role supports patient satisfaction and quality outcomes while complying with Medicaid, private insurance rules and company policies.

Responsibilities include following up on accounts, resubmitting claims, advising on denial trends, assisting families with billing procedures, correcting and rebilling