Reimbursement Representative

USRC's greatest strength in being a leader in the dialysis industry is our ability to recognize and celebrate the differences in our diverse workforce. We strongly believe in recruiting top talent and creating a diverse and inclusive work climate and culture at all levels of our organization.

SUMMARY

The Reimbursement Representative performs reconciliation and review of all outstanding Medicare/Commercial patient balances in accordance with US Renal Care reimbursement policies and procedures.

Essential Duties and Responsibilities include the following. Other duties and tasks may be assigned.

* Reviews EOB/EOMB's for proper reimbursement.

* Resolves electronic claim rejections and Explanation of Benefits denials in a timely manner.

* Reviews and researches insurance correspondence and makes necessary corrections to ensure claims payment.

* Follows up on unpaid/unresolved account balances, including claims rejected electronically, EOB denial and working A/R aging reports as directed. Provides insurance carriers with requested information to facilitate payment.

* Regularly contacts Medicare, Medicaid and /or Commercial payors for resolution to claims not paid or claims not paid according to plan benefits.

* Performs claim appeals as required.

* Assists with credit balance resolution.

* Completes re-bill request as necessary to facilitate timely and proper claims payment.

* Follows up on unresolved account balances including RTP's.

* Prepares adjustment and write-off requests as necessary.

* Performs other duties and responsibilities as required or assigned.

Qualifications/Requirements:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

Requirements include:

* High School diploma or GED require

* At least two years of experience in a health/medical billing and collection office.

* Ability to use copier, fax machine, printer, calculator and multi-line telephone

* Must be proficient with computers with an understanding of medical billing software

* Advanced knowledge of medical terminology as well as knowledge of government and private insurer rules and regulations.

* Advanced knowledge of CPT, ICD-9 and HCPCS coding as well as in-depth knowledge of medical billing requirements

* Working knowledge of Microsoft Outlook, Word and Excel

* Ability to utilize the internet, specifically Medicare and Medicaid websites

* Maintain confidentiality in regard to HIPAA rules and regulations, as well as private company matters