Reimbursement Representative (Hybrid Plano, TX)

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. Candidates should reside in the Dallas / Fort Worth, TX area commutable to Plano, TX.

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 :