Reimbursement Representative

Durham, NC

Job ID: 314879 Industry: Specific
Reimburment Representative - Temp to hire, 9-5: 30, pay is $15/hr

1.0 Job Description (Include primary responsibilities):

1.1 Provide direct support to patients and/or customers regarding authorization and insurance coverage for company related products
1.2 Answer calls from physician offices, hospitals, and patients using exemplary customer service skills
1.3 Accurately enter required information into computer databases and other insurance related data entry to ensure proper and timely billing of claims
1.4 Follow established procedures for submitting authorization and/or verification of eligibility for all requested items, as well as determine member benefit coverage for requested items
1.5 Call patients and/or providers back with information regarding authorization and any funds due
1.6 Maintain patient confidentiality as defined by state, federal and company regulations
1.7 Establish effective rapport and maintain cooperative working relationships with other employees, professional support service staff, customers, clients, patients, families and physicians or other healthcare providers
1.8 Actively support departmental and corporate strategic plans and ensure successful implementation
1.9 Responsible to assist accounts receivable staff in researching unpaid claims related to eligibility, prior authorization and other verification related denials
1.10 Perform day to day administrative functions and general office duties related to the reimbursement department
1.11 Practices confidentiality and privacy protocols in accordance with company policies and HIPAA requirements
1.12 Exercises problem-solving and conflict resolution skills when handling patient complaints and follows company procedures when handling complaints as needed

2.0 Alternate Responsibilities (Include any secondary responsibilities such as a designated signature authority for a primary, etc.):

2.1 Assists in educating and acts as a resource to clinicians and support staff regarding authorizations and insurance requirements
2.2 Working knowledge of federal, state, local and intermediary specific billing requirements to ensure appropriate authorizations are completed and/or notifies appropriate person of missing or incomplete billing requirements and follows up in a timely manner.
2.3 Maintain current knowledge and understanding of government rules and regulations.
2.4 Maintain knowledge of current changes in coding and reimbursement requirements for all payors regarding company products
2.5 Other reimbursement department related tasks as assigned by supervisor or delegated employee
2.6 Accept special projects and assignments as business requires

3.0 Job Tasks (Indicate volume and complexity of work, frequency of activities, etc.):

3.1 All duties listed above are performed on a daily basis


4.0 Hierarchical Position (Include organizational reporting structure, budgetary responsibility, etc.):

4.1 Reimbursement Supervisor


5.0 Required Skill Sets (identify specific computer, audiological, troubleshooting, and other technical skills required for the position):

5.1 Demonstrated knowledge of insurances
5.2 Excellent time management, attention to detail and organizational skills
5.3 Excellent computer, multi-tasking and phone skills
5.4 Ability to handle numerous interruptions from patients, customers, and other departments in a courteous, professional and helpful manner
5.5 Demonstrated critical thinking, creativity, problem solving skills
5.6 Mathematical skills for computing and adjusting dollar amounts for patient balances, claims, billing and collections
5.7 Maintain current knowledge of CPT, HCPCS and ICD-9/10 coding systems
5.8 Understanding of medical billing software and ability to learn
5.9 Ability to work well under pressure and with minimal supervision

6.0 Educational or professional requirements (identify degree / licensure requirements of position. If work experience can be substituted for educational requirement, please note the following below: identified degree/diploma or equivalent work experience

6.1 HS Diploma/equivalent educational degree or equivalent work experience

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