Reimbursement Specialist (Hybrid), Day Shift, Patient Financial Services
Core
Establish payment status, determine denial root causes, contact payers to obtain payment or commitments, and route claims for adjudication within Patient Financial Services.
Role type
Reimbursement Specialist
Builds
Payment collections and claim adjudication processes for healthcare providers
Domain
Healthcare / Medical Billing
Deliverable
client delivery
Required skills
Claims adjudication, denial management, payer communication, appeals processing, claim status tracking, rebilling, EOB review
Preferred skills
Healthcare insurance experience, public health setting experience, outsourcing company experience
Technologies
Payer portals, PC, bill scrubber
Responsibilities
Establish payment status of billed or partially paid claims, determine root cause of denial or partially paid claim, contact payer to determine if additional information is needed, obtain payment or commitment from payer, file appeals after review of denials, request rebill/corrections, route denials to appropriate teams, transfer unpaid balance to patient, review Explanation of Benefits for clarity, process payer changes
Seniority
Mid-level, individual contributor