The Impact You’ll Make in this Role
The Healthcare Reimbursement Specialist role will be responsible for research, analysis and resolution of high volume, complex customer accounts receivable, order entry exceptions and disputes involving contractual agreements and non-standard billing agreements with hospitals, group purchasing organizations, nursing homes and miscellaneous medical service providers requiring durable medical equipment and associated peripheral medical supplies.
As a Healthcare Reimbursement Specialist, you will have the opportunity to tap into your curiosity and collaborate with some of the most innovative and diverse people around the world. Here, you will make an impact by:
- Utilizes higher-level knowledge of accounts receivable practices and information systems to identify and remove barriers to account collection.
- Develop, for insurance claim denials, a reasonable patient product use detail and history; to develop and substantiate the product use evidence, and present the patients case as an appeal insurance companies
- Facilitates high volume, extensive professional level verbal and written communications to a broad spectrum of internal and external contacts during all resolution activities operating within strict federal credit guidelines and in full compliance with Sarbanes-Oxley regulatory requirements.
- Researches and verifies all requisite specific transactional information such as contractual stipulations and service dates, initial order entry information, authorization information, as well as contract information such as reimbursement rates, billing requirements, and limitations of utilization.
- Determines root cause(s) recommends and implements appropriate activities and practices to increase collection of company revenue volume and decrease outstanding accounts receivable.
- Practices continual autonomous decision-making based on knowledge and understanding of a variety of contractual pricing structures.
- Investigate and analyze insurance claims denied reimbursement by reading documents, interfacing with insurance company personnel, patients, and the patient’s physicians and/or nurses, and negotiating computer-based research.
- Perform insurance transfers, post and document insurance claim status within the billing system and generate insurance company denied claim status-follow up in the computer system.
- Determine the necessity of a patient to be directly responsible for a portion of the claim charges not coverage by a primary or secondary insurance carrier.
- Ensures daily production consistently meets stated goals for job position.
- Participates in all reasonable work activities as may be deemed suitable and assigned by management.
- Conforms to, supports and enforces all Company policies and procedures.
Your Skills and Expertise
To set you up for success in this role from day one, 3M requires (at a minimum) the following qualifications:
- High School Diploma/GED or higher (completed and verified prior to start)
- Five (5) years of performing medical collections in a private, public, government or military environment
Additional qualifications that could help you succeed even further in this role include:
- Ability to analyze and resolve complex A/R discrepancies
- Demonstrates knowledge of basic accounting skills.
- PC skills to include use of Microsoft Excel and Word.
- Excellent telephone communication skills and customer service skills.
- Demonstrates excellent problem-solving skills and negotiating skills
- Ability to maintain confidentiality and discretion in business relationships and exercise sound business judgment.