A Medical Reimbursement Specialist is responsible for monitoring and analyzing payments and identify contractual variances, overpayments, underpayments, and denials. Common job duties listed on the Medical Reimbursement Specialist Resume include the following – identifying variances that are due to inappropriate auto proration, reviewing and analyzing the reasons for variance using daily reports and tools; correcting manual or missing proration as per contract or explanation of benefits; identifying denied payments based on the health system, initiating appeal letters or phone calls, prioritizing appeal requests based on contractual appeal timeframes.
Those interested in this field must be able to mention on the resume the following skills and abilities – working knowledge of managed care contract administration and payor requirements; knowledge of patient accounting systems and managed care reimbursement applications, and experience as an insurance collector or denials specialist. Formal education beyond a high school diploma is not mandatory.
Objective : Medical Reimbursement Specialist with 5 years of experience in Creating and organizing raffles, family picnics, employee outings, and other monthly morale-boosting events for employees, Corresponding with businesses within the area to maintain business relationships and to obtain discounts for the members.
Skills : Excellent Written And Verbal, Detailed Oriented, Organized Self-starter, With The Ability To Assimilate New Information Quickly And Able To Multi-task Well.
Description :
Responsible for billing, collecting, post payment review, credit balances and correspondence functions of all aged government, non-government and patient accounts Adheres to departmental standards to not make, take, or pass mistakes.
Identified possible trends or issues and provides possible solutions.
Communicated and escalated information to Leadership Prepare and submit appeal for various denials (i.e. under payment, untimely filing, and retro authorization request, investigational and not medically necessary.).
Reviewed outpatient claims on HCFA 1500 to commercial and private insurance, Medicare, Medi-Cal and various Managed Care medical plans such as HMO, POS, EPO, and Medicare Advantage Plans.
Maintained ongoing knowledge of all standard bill forms and other mandatory state billing forms and filing requirements Assures that high performance work team is developed through coaching, mentoring Prompt resolution of issues, problems and opportunities.
Generated enthusiasm and commitment among employees Provides continuous educational and coaching toward improvement.
Fostered a High Performance Work Team Environment Work and training employees by empowering, coaching, answering questions, giving guidance, and leading by example.
Experience
2-5 Years
Level
Executive
Education
GED
Medical Reimbursement Specialist Resume
Headline : To obtain a Medical Reimbursement Specialist position that will benefit from my experience and contribute to my professional growth as a customer service representative in the telecommunication industry.
Skills : Efficient In Microsoft Office, Multitasking.
Description :
Served as a Medical Reimbursement Technician in the Central Plains CPAC at the Department of Veterans Affairs.
Responsible for the verification of Veterans' insurance coverage for inpatient services.
Entered updated information and maintaining the VISTA, Quadramed, HURON, Microsoft Access, Excel, and Word database.
Verified benefits, policy numbers, pre-certification requirements, insurance contact information, and effective dates of coverage.
Responsible for all reimbursable billing activities, including consideration of professional services and facility services, sharing agreements, Medicare, and pharmacy billing.
Ensured that all billable cases are identified and that bills are generated using ICD-9-CM, CPT-4 and HCPCS codes.
Validated claims for billing purposes ensuring eligibility and referring questionable coding for review, monitor reports to assure all possible billable cases are processed and ensure proper sequencing of diagnostic and procedural codes and assigns modifiers as needed.
Experience
5-7 Years
Level
Executive
Education
Bachelor's In Occupational Education
Medical Reimbursement Specialist Resume
Objective : Acute hospital, Psych and Home health revenue cycle management of Medical account receivables. Billing and Collections experience with various office patient accounting systems and insurance filing and tracking programs. Attention to detail, customer service driven and account review and resolve professional.
Skills : Medical Billing And Coding, Medical Terminology, Collections, ICD-9, ICD-10, HCPCS-coding, Call Center Experience.
Description :
Performed first and second level application support for all existing applications.
Maintained the constants data base for each facility, Auditing the application to ensure maximum performance, problem diagnosis, and resolution.
Assisted with creating additional databases for new facilities.
Systems trained of existing employees and new hires on all employer's A/R application programs.
Policy and procedured development and updating.
Researched outstanding Medicare, Commercial and Blue Cross insurance accounts.
Worked accounts from the ATB report per each financial class.
Experience
2-5 Years
Level
Junior
Education
Associates In Computer Accounting
Medical Reimbursement Specialist Resume
Summary : To collaborate with health care professionals and process insurance reimbursements. To ensure clients receive accurate reimbursement for their claims, update appropriate files, investigate claim issues and make recommendations to the health care unit's management. Display proficient knowledge of payer trends.
Skills : Epic, IDX, E-clinical Works, Cerner, Medical Manager.
Description :
Used IDX/PCS work files to track timely follow-up of outstanding claims.
Performed collection activity on open insurance claims exercising billing knowledge.
Accurately communicated verbally with internal teams and external customers (third-party payers).
Reviewed incoming insurance correspondence and responds with accurate written documentation.
Used a proactive approach in identifying and bringing patterns/trends to management's attention recoding and compliance, contracting, and credentialing for any potential in delay/denial of reimbursement.
Accurately entered and /or updated patient/insurance information into the IDX system.
Appealed claims to assure contracted amount is received from third-party payers.
Experience
7-10 Years
Level
Management
Education
Associate In Science In Business Management
Medical Reimbursement Specialist Resume
Headline : Researching, collecting, and analyzing data problems from multiple sources and provide appropriate results and posts payments, adjustments, denial codes, and non-payment collections.
Skills : Computer, Customer Service, Faxing, Typing, Data Entry, Collections.
Description :
Employed as a Reimbursement Specialist with a Rural Health Clinic in Laurens, SC.
Made corrections to errors and resubmit claims for processing in a timely manner.
Filed primary, secondary, & tertiary claims via mail or internet to various insurance companies.
Filed and follow-up Worker's Compensation claims.
Assisted with collection issues due to delinquent accounts.
Compiled and maintained the aging target for assigned payers within standards established by department and insurance guidelines.
Verified daily electronic claims submission.
Experience
5-7 Years
Level
Junior
Education
BS In Medical Coding
Medical Reimbursement Specialist Resume
Objective : Conducting appropriate claim follow-up on all open A/R to ensure prompt adjudication, maximize revenue and maintain the practices Key Performance Indicators, and also Performing daily ERA, EOB, Rx, and patient payment posting.
Contacted patients and insurance companies to verify and resolve claims for payment.
Downloaded demographic information from various clients, including hospitals.
Recorded daily cash totals, weekly credit card totals, and posting EOB's manually.
Reviewed AR reports determining to follow-up, i.e. resubmissions, adjustments, and refunds.
Reviewed accounts for collections.
Utilized current ICD-9 and HP CPT-4 codes.
Responsible for third-party collection from insurance companies.
Experience
2-5 Years
Level
Junior
Education
G.E.D
Medical Reimbursement Specialist Resume
Objective : Medical Reimbursement Specialist with 3 years of experience in Reviewing and monitoring clearinghouse claim errors and global payer rejections for possible system edits or payer updates, Analyzing payer denial trends, strategize and test various billing methodologies, and payer coding requirements to ensure payment of all claims due to the practice.
Skills : Microsoft Office, Pharmacy Billing Adjudicating Claims.
Description :
Responsible for electronic daily billing on Pharmacy / Medical claims for all major insurance carriers, third-party vendors, and Medicaid / Medicare.
Ensured charges were entered accurately and in a timely manner.
Ensures charges are consistent with services rendered.
Obtained eligibility information and verified claims will be covered.
Obtained authorization if needed for the claim processing.
Verified Medicaid DRG charts to ensure procedures have been billed correctly.
Researched and resolved billing discrepancies for patients, insurance carriers, third-party vendors, and Medicaid and Medicare.
Experience
2-5 Years
Level
Executive
Education
BS In Pharmacy Technician
Medical Reimbursement Specialist Resume
Headline : Ensuring month-end activities are completed in a timely manner and that month-end reconciliation is accurately completed prior to contractual deadlines.
Skills : Microsoft Office, Leadership.
Description :
Performed billing functions in our inpatient and outpatient medical center.
Obtained insurance cards for scanning in the system.
Pre-certified medical appointments with insurance companies for all inpatient admissions.
Performed telephone/in-person interviews and inquiries with veterans and their families to determine eligibility for VA treatment center.
Reviewed medical documentation of scheduled outpatient visits/entered appointments via Vista medical appointment software.
Collected all pertinent information for veterans either through a phone interview or an in-person check-in procedure.
Mitigated any problems and concerns of the patient, his family, or representatives to make their encounter with the VAMC as comfortable and enjoyable as possible.
Explained in detail to the veterans and their families the amounts due for services not covered by the VAMC.
Experience
5-7 Years
Level
Junior
Education
A.A.S. In Paralegal Practice
Medical Reimbursement Specialist Resume
Objective : To acquire a challenging Medical Reimbursement Specialist position in an industry where I can best utilize my extensive skills and education and add value to an organization.
Skills : Epic, Microsoft Office, Managing Skills.
Description :
Reviewed and prepared claims for electronic and hard copy billing submission.
Identified and corrected billing errors and resubmitting claims to insurance carriers.
Provided review and remittance advice for payment errors, denials, and underpayments.
Acted cooperatively and courteously with patients, visitors, co-workers, and management.
Initiated appeals when necessary.
Consolidated account aging reports.
Assisted with billing inquiries from patients.
Experience
2-5 Years
Level
Executive
Education
BS In Medical Terminology
Medical Reimbursement Specialist Resume
Summary : Running all reports needed to successfully manage the claims business for specified payers/financial classes, and also Ensuring the practices claim KPIs are satisfied within specified payer group(s).
Skills : Microsoft Word, Multitasking.
Description :
Established and maintained effective relationships with customers and gains their trust and respect Understanding of the requirements of Medicaid, Medicare, and Insurance billing Handling inbound/outbound calls Direct interaction with key endocrinologists' offices as well as managing relationships and casework.
Reviewed unpaid accounts to determine status and taking appropriate action to ensure payment.
Reviewed all claims for compliance and completeness for claims submissions.
Reviewed daily billing edit reports for electronic claims.
Contacted payers, via the website, phone, and/or correspondence, regarding reimbursement for unpaid accounts over thirty (30) days or more, by researching and following up on denials and requests for additional information.
Included contacting patients as needed to collect appropriate information or to collect patient balances.
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