Healthcare Reimbursement Collections Representative
Sincerus Solutions Lexington, MA
- Expired: over a month ago. Applications are no longer accepted.
- Reimbursement Representative is responsible for accurate claims submission and accurate payment of claims according to Health Plans.
MAJOR DUTIES AND RESPONSIBILITIES:
- Assures billing processes are compliant with payer requirement for Government, Commercial Health Plans and Medical Group payers.
- Assures accurate billing of coding and units required by payer and therapy type
- Analyze and rectify claims issues with payers by timely follow u of claim status/payment.
- Ensures accuracy and completeness of payer requirements prior to timely submission of claims to Health Plans, either electronic or hard copy.
- Assures required authorizations and medical documentation forms are in correspondence with claim submission for quick turn-around time
- Reviews and assures claims are processed and paid in full according to contractual agreements.
- Ensures revenue is booked according to appropriate contract allowables.
- Communicates with branches and other departments to assure resolution of reimbursement issues.
- Communicates and addresses reimbursement issues with management for resolution in a timely manner.
- Handles collections calls promptly with professionalism to payers and/or patients.
- Must be able to prioritize, multi-task, meet goals and deadlines.
- Protects patient health information by following regulations for HIPAA compliance.
- Ensures daily productivity is met and monthly and monthly closing goals are met.
- Performs other related duties as directed by Supervisor.
EDUCATION AND/OR EXPERIENCE:
- High School Diploma or equivalent education.
- Candidate must be experienced with a minimum of 1-2 years (not including school or externship) in Home Infusion
- Knowledge and understanding of HCPC and CPT codes
- Candidate must be a self-starter and motivated to research and resolve issues
- Ability to work independently with minimal supervision and prioritize to meet deadlines, as well as ability to work in a collaborative manner
- Strong understanding of insurance terms, medical terminology, pricing methodologies for commercial and government billing requirements.
- Proven solution-oriented attitude
- Microsoft Word and Excel
- Demonstrates positive interpersonal relations in dealing with supervisors, co-workers and other employees so that productivity and positive employee relations are maximized.
- Exhibits a positive attitude toward the organization, his/her job and others.
- Shows concern and respect for others by dealing with people in a compassionate, sensitive and responsive manner.
- Promotes change and is proactive in suggesting change and new ways of doing things.
- Respects the confidentiality of others.
- Complies with company policies including employee handbook, quality improvement and safety guidelines.
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