Reimbursement Specialist

Job Overview

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 :

• 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.
• Perform collection tasks to obtain payments from third party payers, government, and private accounts.
• Negotiate payment plan arrangement with delinquent patient accounts.
• Prepare and request any credit or debit adjustments.
• Research and refund patient or insurance company for overpayments.
• Request adjustments on incorrectly processed claims.
• Review and process correspondence.
• Patient orders.
• Rejections / denials.
• Medical record requests.
• Itemized bills.
• Clarification of detail on bill.
• Maintain and update patient accounts.
• Screen claims online and or on paper for accuracy.
• Assist clients regarding billing questions and ensure appropriate resolution of problem(s).
• Document and maintain files.
• Process third party payers and patient remittances.
• Interpret and demonstrate accurate application of third-party payer EOB's.
• Understand Federal, State and other third-party payer requirements needed to prepare and process payments.
• Document and maintain files to support reconciliation of amount posted to amount deposited.
• Post receipts within two working days after deposit.
• Prepare, scan and file documents in appropriate area.

Required Qualifications :

Preferred Qualifications :

Benefit Overview

Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more! Please follow this link for additional information.

Compensation Disclaimer

An individual's pay rate within the posted range may be determined by various factors, including skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization prioritizes pay equity and considers internal team equity when making any offer. Hiring at the maximum of the range is not typical. If your role is eligible for a sign-on bonus, the bonus program that is approved and in place at the time of offer, is what will be honored.

EEO Statement

EEO / Vet / Disabled : All qualified applicants will receive consideration without regard to any lawfully protected status