Job Title: Medical
Supervised by: Coordinator, Billing
Location: Greer, SC
Weekly Hours: Full-Time
Position Overview: Looking
for a goal-oriented Medical Reimbursement Specialist who is highly accurate and
motivated to provide financial, administrative, and clerical services and to
ensure accuracy and efficiency of operations. This position is responsible for
following up on unpaid claims, utilizing monthly aging reports, filing appeals
when appropriate to obtain maximum reimbursement, verifying and submitting
accurate corrected claims, and establishing strong relationships with patients,
insurance representatives, and insurance companies.
claims are processed and paid with a goal of zero errors. Verifies completeness
and accuracy of all claims prior to submission. Utilizes clearinghouse to
download electronic payments and process rejections.
interprets insurance explanation of benefits.
Timely follow up
on insurance claim denials, exceptions or exclusions. Meets deadlines. Utilizes
monthly aging reports to follow up on unpaid claims aged over 30 days.
arrangements for medical records requests, completion of additional information
requests, ect. as requested by insurance companies. Submits appeals when
appropriate for reimbursement.
inquiries from insurance companies, patients, and providers.
with Billing Coordinator to discuss and resolve reimbursement issues or billing
obstacles. Participates in educational activities and attends monthly
strictest confidentiality; adheres to all HIPAA guidelines/regulations; also
conducts self in accordance with the Tribe employee handbook.
an overall desire to practice the Tribe Way through humility, and exemplify a
servant’s attitude towards others in the department, company, and patient
population. Works to maintain integrity and excellence in every area of the job
description and show initiative towards others by practicing conscious
leadership in the role.
High School Diploma or
equivalent. Prefer experience in Medical Billing and Coding or Accounting;
however, physician practice experience in lieu of education will also be
medical billing/collection practices, basic medical coding, and third-party operating
procedures and practices.
business office procedures including computer programs as well as the ability
to operate a computer and basic office equipment. Well organized and
operate a multi-line telephone system
patient communication with a pleasant and helpful manner as well as the ability
to establish and maintain effective working relationships with patients,
employees and the public
Normal office environment.
Occasional overtime may be required and/or hours may be shortened as business
sitting and standing associated with a normal office environment. Manual
dexterity needed for using a calculator and computer keyboard. This description
is intended to provide only basic guidelines for meeting job requirements.
Working conditions, skills and responsibilities may change as needs evolve.