CareMedic Systems

Reimbursement Specialists (Self-Pay, Insurance Follow-up, Medicare, Medicaid)

Department: Service Delivery
Reports To: Reimbursement Supervisor
Status: Regular, Full Time
Category: Hourly, Non-exempt
Location: Alpharetta, GA
Revision Date: February 5, 2009


Position Summary:
 
This position will be responsible for the day-to-day functions of, and meeting the overall goals of each assigned project. The associate will also be responsible for working assigned accounts to completion while maintaining the quality and quantity standards set forth by management.

Essential Duties and Responsibilities: 

• Responsible for analyzing previous account documentation in WebMats, HIS and other available sources, in order to determine the appropriate action(s) necessary to resolve each assigned account. Assigned accounts may come from various sources to include but not limited to specialized reports. 
• Responsible for initiating the next billing, follow-up and/or collection step(s), which is not limited to calling patients, insurers or employers, as appropriate. (See Areas of Specialization below). 
• Responsible for documenting in WebMats and HIS (where required) the billing, follow-up and/or collection step(s) that are taken as well as the result and next step needed to resolve the assigned accounts. 
• Utilize WebMats Action Codes to appropriately represent the action(s) taken or pending in order to resolve the assigned accounts. 
• Responsible to stay in constant communication with Reimbursement Supervisor and Senior Reimbursement Specialist regarding all aspects of assigned projects. 
• Understand the workings of WebMats and be able to update information as needed. 
• Maintain professionalism to ensure the highest quality of results and client satisfaction. 
• Other duties as assigned

Areas of Specialization: 

Self Pay/Customer Service Specialists: 

• 2-3 yrs of healthcare patient accounting exp. 
• Must possess understanding of common medical insurance/healthcare industry language 
• Possess expertise and comfort level in speaking directly with patients regarding balances 
• Ability to accurately read and interpret EOBs 
• Possess excellent telephone etiquette and customer service skills

Billers 

• 2-3 yrs of healthcare patient accounting exp., with 1-2 yrs devoted to medical billing 
• Ability to correctly bill various insurances 
• Proficient knowledge of value codes, condition codes and modifiers 
• Must understand UB-04 and CMS 1500Must have strong knowledge of ICD-9 
• Possess strong analytical and research skills 
• Insurance Follow-up (including Second Pay) 
• 2-3 yrs of healthcare patient accounting exp., with a focus on non-gov't insurance follow-up 
• Possess verifiable knowledge of managed care protocols for coverage, based on illness/injury and whether provider is in or out of network 
• Possess in-depth understanding of claim denials and actions required for insurance payment/resolution (know when to escalate)

Medicare Specialists: 

• 2-3 yrs of healthcare patient accounting exp., with a focus on Medicare Part A & Part B 
• Ability to accurately review and correct claims
•  Possess working knowledge of Medicare Regulatory Guidelines 
• Medicare claim resolution (from open to close – not solely status) 
• Must possess working knowledge of Florida Shared System (FSS) 
• Must understand UB-04 and CMS 1500 
• Medicaid Specialists 
• 2-3 yrs exp. of healthcare patient accounting exp., with a focus on Medicaid in multiple states (GA + at least one other) 
• Ability to review and correct Medicaid claims (on-line) 
• Possess proficiency in Medicaid regulations & guidelines 
• Must understand UB-04 and CMS 1500 
• Must possess in-depth understanding of crossover claims

Qualifications: 

• General PC knowledge with good typing skills. Excel and

• Word a plus but not required. 
• Possess strong interpersonal skills for dealing professionally with clients and patients. 
• Must be able to speak clearly and audibly while working directly with payors, clients and patients. 
• Dependable, flexible, and able to work in a team environment. 
• Ability to work in a production environment and be goal oriented. 
• Ability to use analytical skills to determine appropriate actions. 
• Must possess excellent organizational skills and be able to prioritize workflow. 
• Ability to regularly demonstrate excellent follow-up. 
• High school diploma or equivalent required. CPAR or CPAT a plus. 
• Minimum 2 to 3 years experience in related healthcare accounts receivable desired. 
• May be required to travel within your general area. 
• CPAR certification desirable.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to use hands and arms, including the need to reach with arms. The employee is frequently required to sit; stand; walk; reach with hands and arms; balance; stoop; kneel and/or crouch. The employee must occasionally lift and/or move up to 20 pounds.


Work Environment

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly exposed to computers, printers and copiers. The noise level in the work environment is usually moderate.

Travel

On-site projects may require 80-100% travel nationally.