Reimbursement Specialist

Overview

Do you have at least one year of medical business office or pharmacy technician experience? We at MHealth Fairview are looking for you to join our amazing Kasota team located in Minneapolis! This benefits eligible position is a 1.0FTE (80 hours/ 2 weeks) on the day shift.

Provide superior customer service in person and on the phone to internal/external customers. Generate and monitor aging reports. Responsible for day to day functions of assigned accounts, to include but not limited to. Maintain and update billing activity. Ensure accurate and timely billing, collections, appeal of home infusion claims. Perform collection tasks to obtain payments. Analyze accounts for documentation, authorization, diagnosis, and all necessary information to determine the next step in the process. Process third party and patient remittances, including posting payments, credits, and adjustments. Timely and accurate application of payments on third party and patient accounts.

Responsibilities/Job Description

Provide superior customer service, in person and on the phone, to all insurance companies, Fairview entities, and patients.

• Communicate effectively, both written and verbal

• Communicate appropriate information to others according to established procedures to support day-to-day operations

Process home infusion claims accurately and timely.

• Review accounts for all needed information and communicate to correct departments to add information needed to ensure proper billing.

• Screen claims on-line or on paper for accuracy

• Obtain appropriate information to process claims

• Communicate and request necessary information from payers, patients, Fairview Department

Interpret and demonstrate accurate application of third party payer and government payer contracts.

• Understand regulatory, HMO, PPO, Federal, State and other third party payer requirements needed to prepare and or process claims

Generate and monitor aging reports on third party payers

• Communicate denials and Eligibility of Benefits (EOB's) to insurance company and patients

• Review aging reports that have reached certain aged categories (30,60,90 days,etc.)

• Maintain reports to 60 days

• Generate home infusion claims for resubmission for third party payer's outstanding balances.

Prepare and request any credit or debit adjustments

• Research and refund patient or insurance company for overpayments

• Request adjustments on incorrectly processed claims

Qualifications

Education:

Minimum Education

• High School Diploma/GED

Preferred Education

• Vocational/Technical Training or Associate Degree or Certified Medical Billing

Experience:

Minimum Experience

• 1 year medical business office or pharmacy technician experience

• Six months customer service or data entry experience

Preferred Experience

• Three + years medical billing or collection experience, Medicare, Medicaid, Third Party experience