Reimbursement Specialist

Cardiology Specialists of Acadiana is seeking a medical Reimbursement Specialist.

Position Summary

            Achieves maximum revenue collections from insurances and patients through timely entry, filing and follow-up; maintains thorough and accurate transaction and correspondence on patient accounts; provides insurance claims education to patients; posts payments & adjustments; reconciles batches and accounts

 Job Responsibilities

• Demonstrates thorough understanding of all medical insurance terminology, ICD-10 coding, CPT-4 coding, remittance advices and explanation of benefit forms.
• Understands health insurance guidelines, esp Medicare, Medicaid, HMOs, PPOs
• Understands how to post a remittance advice or explanation of benefits, electronically or manually.
• Files primary and secondary claims timely.
• Batches and posts insurance & patient payments and adjustments correctly in accordance with policy and procedure and assigned timeframe.
• Ensures accounts of assigned alphabet are managed timely for outstanding insurance, denials, filed rejected, appeals for payment within 30 days
• Follows-up on unresolved claims no less than every 30 days.
• Thoroughly documents tasks performed on each patient account in EMR.
• Seeks patient collections on overdue accounts.
• Processes and enters charges with correct diagnoses and modifiers within 48 hrs of charge availability in billing module; prepares clean and timely claim for insurance
• Greets patients in a friendly and professional manner, whether in person or via telephone, determines their needs and responds accordingly; educates patients on insurance as needed.
• Obtains and/or reviews current & accurate demographic and insurance data relative to dates of service, including insurance cards into patient registration system.
• Verifies medical insurance coverage and documents benefits information as needed.
• Utilizes EMR and PM system accurately.
• Perform any other services deemed reasonable by physician or supervisor.

Education and Experience:  High school diploma or equivalent. A minimum of one year’s experience in a medical office or other healthcare setting.  Certification and/or experience in reimbursement preferred.