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Reimbursement Specialist Job in Austin, Texas

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Job Title: Reimbursement Specialist

Employer:Texas Medical Association
Job Location:Partial Remote
Required Experience:5 to 7 years
Location:401 W.15th Street Austin 78701, TX, US
Date Posted:5/4/2021

DEPARTMENT       Reimbursement Services 

SUPERVISOR         Manager, Practice Management and Reimbursement Services



To serve as a resource for physicians in coding, claims, and reimbursement-related activities.



  1. Serve as a reimbursement resource for physicians and practice managers related to proper coding and billing for medical services, and Medicare, Medicaid, and third-party payment policies.
  2. Serve as department staff for the Billing and Coding Hotline.
  3. Triage Reimbursement Review and Resolution (RRR) forms and supporting documentation to determine what action should be taken which may include but not be limited to: entry into the RRR database; request to the health plan via letter or personal contact for resolution; personal contact with the physician office requesting additional information about the issue; or educating physician office on correct coding/billing. Extensive research of the issue is conducted through resources available online.
  4. Develop and maintain educational materials including, but not limited to, CPT codes, modifiers, and billing policies (e.g. incident to billing, locum tenens, and refunds.)
  5. Participate in carrier meetings with health plans and government-sponsored health programs as assigned. Collate potential meeting agenda items and examples for carrier meetings assigned to other department staff.
  6. Participate in or develop presentations and Billing Cure programs with other department staff and in conjunction with county medical societies.
  7. Research and summarize Texas and Federal laws and regulations related to healthcare.
  8. Provide the Communications Division with physician reimbursement information to be used in TMA communications vehicles as appropriate.
  9. Maintain current knowledge in physician reimbursement issues by attending seminars and monitoring listservs/web sites and workshops related to Medicare, Medicaid, commercial health insurance and other physician payment methodologies.
  10. Develop a network of relationships with third-party payers to strengthen advocacy activities in the area of physician reimbursement.
  11. Perform other related duties as directed or required.


No supervisory responsibility.


Assignments are complex and may vary greatly.  They require the exercise of independent judgment regarding the definition of basic problems and determination of courses of action to be taken. Duties are performed independently to achieve assigned objectives; however, methods and procedures may not be specifically defined.  Employee may be required to develop or research appropriate methods and procedures to be used.  



Knowledge and Experience:

Requires concentrated understanding of a comprehensive field of knowledge.  Knowledge required is normally equivalent to the attainment of a bachelor’s degree in related field or 5 to 10 years of experience.  Must be able to work with co-workers, physician members, and council leaders in examining complex reimbursement and related policy issues if needed. Experience with preparing health insurance claims and researching insurance policies and procedures preferred. Thorough experience with Texas Medicaid program preferred.


Skills and Abilities:

Ability to understand and follow oral and written instructions and deal effectively with other TMA employees and members.  Must be familiar with researching health plans and government-sponsored health programs. Must be organized and able to plan work which requires evaluating facts to determine courses of action.  Strong oral communication and interpersonal skills are essential.  Effective, proficient writing skills are required. Must be skilled in Microsoft Word, Outlook, PowerPoint, and Excel. Ability to work in a team environment is critical. Designation as a Certified Professional Coder (CPC) or other professional coding certification required. Medical office management or health plan experience necessary.



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