Charter Oak Health Center, Inc.
Medical Reimbursement Specialist
Charter Oak Health Center, Inc., Hartford, Connecticut, us, 06112
Medical Reimbursement Specialist
Charter Oak Health Center is seeking a Medical Reimbursement Specialist to join our team. In this role, you will manage insurance balances, follow up with insurance companies, submit appeals for denied claims, and ensure accurate payment of claims. You will also coordinate adjustments, contractual allowances, and refunds, identify denial reasons, and stay current with insurer policies and contracts.
Essential Position Duties
Identify root causes behind insurance denials and stay up to date with payer policies, contracts, and bulletins.
Share information on trends related to payer denials for specific procedures or diagnosis codes with management.
Resolve insurance balances accurately after payments are made, identifying any patient costs and ensuring accounts are correctly settled according to payment terms.
Follow up with payers to ensure outstanding claims are resolved quickly using phone calls, emails, faxes, or websites.
Use both internal and external resources to analyze patient accounts and take action to resolve payment issues, documenting all activities according to organizational and payer policies.
Submit Letters of Medical Necessity (LOMN) with appeals for claims that were rejected or denied.
Continue to check accounts and escalate issues if a denial is not overturned.
Work with Patient Access, Medical Coding Coordinator, Patient Service Representative, and Eligibility Coordinators to resolve denials related to medical necessity, eligibility, referrals, or authorization.
Set follow-up actions based on how the claims are progressing and ensure clear documentation in the system.
Work with team members on special projects to achieve timely deliverables, communicate results effectively, and complete other assigned tasks.
Compliance Responsibilities
Comply with applicable legal requirements, standards, policies, and procedures, including but not limited to those within the Compliance Process, Code of Conduct, HIPAA, and Corporate Integrity Agreement (CIA).
Participate in required orientation and training programs, as required.
Report concerns and suspected incidences of non-compliance in accordance with COHC Compliance Reporting Process.
Cooperate with monitoring and audit functions and investigations.
Participate, as requested, in process improvement responsibilities.
Professional Experience/Educational Requirements
High School Diploma/GED or minimum of 2 years direct experience with an Associate or Bachelor's degree from an accredited program.
Minimum of 3 years’ billing experience required in healthcare revenue cycle with specialization in billing, account receivable follow-up, and denial management.
Two years of accounting experience and strong knowledge of accounting theory and methods.
Certification/Licensure
Certified Medical Biller (not required)
Certified Revenue Cycle Specialist (not required)
Salary: $21.00 - $25.00 per hour.
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Essential Position Duties
Identify root causes behind insurance denials and stay up to date with payer policies, contracts, and bulletins.
Share information on trends related to payer denials for specific procedures or diagnosis codes with management.
Resolve insurance balances accurately after payments are made, identifying any patient costs and ensuring accounts are correctly settled according to payment terms.
Follow up with payers to ensure outstanding claims are resolved quickly using phone calls, emails, faxes, or websites.
Use both internal and external resources to analyze patient accounts and take action to resolve payment issues, documenting all activities according to organizational and payer policies.
Submit Letters of Medical Necessity (LOMN) with appeals for claims that were rejected or denied.
Continue to check accounts and escalate issues if a denial is not overturned.
Work with Patient Access, Medical Coding Coordinator, Patient Service Representative, and Eligibility Coordinators to resolve denials related to medical necessity, eligibility, referrals, or authorization.
Set follow-up actions based on how the claims are progressing and ensure clear documentation in the system.
Work with team members on special projects to achieve timely deliverables, communicate results effectively, and complete other assigned tasks.
Compliance Responsibilities
Comply with applicable legal requirements, standards, policies, and procedures, including but not limited to those within the Compliance Process, Code of Conduct, HIPAA, and Corporate Integrity Agreement (CIA).
Participate in required orientation and training programs, as required.
Report concerns and suspected incidences of non-compliance in accordance with COHC Compliance Reporting Process.
Cooperate with monitoring and audit functions and investigations.
Participate, as requested, in process improvement responsibilities.
Professional Experience/Educational Requirements
High School Diploma/GED or minimum of 2 years direct experience with an Associate or Bachelor's degree from an accredited program.
Minimum of 3 years’ billing experience required in healthcare revenue cycle with specialization in billing, account receivable follow-up, and denial management.
Two years of accounting experience and strong knowledge of accounting theory and methods.
Certification/Licensure
Certified Medical Biller (not required)
Certified Revenue Cycle Specialist (not required)
Salary: $21.00 - $25.00 per hour.
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