The Medical Reimbursement Specialist will be responsible for document retrieval, analysis, claim processing, and reimbursement. Has a full understanding of a medical claim cycle and possess the necessary knowledge to identify claim issues and to apply and resolve.
ESSENTIAL DUTIES AND RESPONSIBILITIES :
Submit medical claims to appropriate payer. Ensure resubmission of claims, when applicable, are accurate. Ensure reimbursement of claims by submitted the most appropriate coding for services performed. ICD diagnosis coding, modifier application and verification of CPT and/or HCPCS codes. Responsible for ensuring all claims processed through Emdeon (Change Healthcare) are correct and compliant. Responsible for performing payer enrollment follow up· Keeps abreast of and comply with coding guidelines and reimbursement reporting requirements. Daily review and follow up on all incomplete electronic provider-billing encounters. Identify issues, correct code and/or pend due to missing information. Keep up to date on medical insurance rules and proper filing guideline. Answer patient calls/questions, clinic staff calls, and insurance company calls. Maintain a professional relationship with insurance companies and patients. Other duties as assigned. QUALIFICATIONS AND REQUIREMENTS Minimum 3 years of experience of medical ICD & CPT coding experience preferred. Electronic Medical Record experience, Emdeon (Change Healthcare) software highly preferred Proficient with Microsoft Office Suite. Excellent verbal and written communication skills Excellent organizational and time management skills. Analytical, problem solving, and critical thinking skills. Ability to organize, coordinate, prioritize, and facilitate on-going tasks. Ability to work independently and with a team. EDUCATION High School Diploma or equivalent required Medical Billing/Coder Certification from accredited entity. PHYSICAL DEMANDS
Requires sitting, standing, and occasional light lifting.
ProCare Rx will never ask for a financial commitment from an applicant as part of our recruitment process. All interviews are conducted in-person OR through video conference invitations from official company emails. For inquiries, please contact our official recruitment team at or email us at .
ProCare Rx is an Equal Opportunity Employer.
