Pafford Medical Services
Insurance Reimbursement Specialist
Pafford Medical Services, Paragould, Arkansas, United States
Overview
Insurance Reimbursement Specialist at Pafford Medical Services located at Southwest Arkansas Regional Medical Center, Hope, Arkansas. This role supports hospital revenue cycle by following up on claims and optimizing reimbursement in compliance with federal, state, and payer-specific regulations. Description
Southwest Arkansas Regional Medical Center is a hospital dedicated to delivering high-quality healthcare to the Hope, Arkansas community and surrounding areas. We offer a full range of inpatient and outpatient diagnostic services, as well as a 24-hour emergency department, an inpatient geriatric behavioral health unit, physical therapy, inpatient pharmacy services, and a Rural Health Clinic. The Insurance Reimbursement Specialist is responsible for ensuring timely and accurate follow-up on claims, collections, and reimbursement from insurance companies for all hospital services. Responsibilities
Follow up on all unpaid or denied claims from commercial insurers, Medicare, Medicaid, and other third-party payers. Investigate and resolve claim denials or underpayments, including submitting appeals and corrected claims. Communicate with insurance carriers and internal staff to clarify claim status and resolve issues. Post and reconcile payments received from insurance companies and coordinate adjustments as needed. Review patient accounts to ensure proper billing, coding, and documentation accuracy before collection follow-up. Maintain records of all insurance correspondence, claim status, and follow-up actions. Identify trends in denials or payment delays and collaborate with HIM, coding, and billing staff to correct recurring issues. Educate providers and staff on insurance documentation and claim submission requirements to prevent errors. Generate reports on outstanding claims, denials, and collection activity for management review. Ensure compliance with HIPAA, hospital policies, and payer regulations in all insurance communication and documentation. Education & Experience
High school diploma or equivalent (required). Associate degree in Healthcare Administration, Accounting, or related field preferred. Minimum 2 years of experience in insurance follow-up, claims management, or medical billing/collections required. Prior experience in a Critical Access Hospital setting or knowledge of CAH billing is preferred. Skills & Abilities
Strong knowledge of insurance claim processes, payer guidelines, and reimbursement rules. Familiarity with Medicare, Medicaid, and commercial insurance billing. Ability to analyze accounts, identify issues, and implement solutions. Proficiency with electronic health records (EHR), billing software, and claim management systems. Excellent verbal and written communication skills. Strong organizational and time management skills. Job Details
Seniority level: Entry level Employment type: Full-time Job function: Finance and Sales Industries: Medical Practices Note: This posting contains the relevant responsibilities and qualifications for the Insurance Reimbursement Specialist role. Apply through the company portal as indicated.
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Insurance Reimbursement Specialist at Pafford Medical Services located at Southwest Arkansas Regional Medical Center, Hope, Arkansas. This role supports hospital revenue cycle by following up on claims and optimizing reimbursement in compliance with federal, state, and payer-specific regulations. Description
Southwest Arkansas Regional Medical Center is a hospital dedicated to delivering high-quality healthcare to the Hope, Arkansas community and surrounding areas. We offer a full range of inpatient and outpatient diagnostic services, as well as a 24-hour emergency department, an inpatient geriatric behavioral health unit, physical therapy, inpatient pharmacy services, and a Rural Health Clinic. The Insurance Reimbursement Specialist is responsible for ensuring timely and accurate follow-up on claims, collections, and reimbursement from insurance companies for all hospital services. Responsibilities
Follow up on all unpaid or denied claims from commercial insurers, Medicare, Medicaid, and other third-party payers. Investigate and resolve claim denials or underpayments, including submitting appeals and corrected claims. Communicate with insurance carriers and internal staff to clarify claim status and resolve issues. Post and reconcile payments received from insurance companies and coordinate adjustments as needed. Review patient accounts to ensure proper billing, coding, and documentation accuracy before collection follow-up. Maintain records of all insurance correspondence, claim status, and follow-up actions. Identify trends in denials or payment delays and collaborate with HIM, coding, and billing staff to correct recurring issues. Educate providers and staff on insurance documentation and claim submission requirements to prevent errors. Generate reports on outstanding claims, denials, and collection activity for management review. Ensure compliance with HIPAA, hospital policies, and payer regulations in all insurance communication and documentation. Education & Experience
High school diploma or equivalent (required). Associate degree in Healthcare Administration, Accounting, or related field preferred. Minimum 2 years of experience in insurance follow-up, claims management, or medical billing/collections required. Prior experience in a Critical Access Hospital setting or knowledge of CAH billing is preferred. Skills & Abilities
Strong knowledge of insurance claim processes, payer guidelines, and reimbursement rules. Familiarity with Medicare, Medicaid, and commercial insurance billing. Ability to analyze accounts, identify issues, and implement solutions. Proficiency with electronic health records (EHR), billing software, and claim management systems. Excellent verbal and written communication skills. Strong organizational and time management skills. Job Details
Seniority level: Entry level Employment type: Full-time Job function: Finance and Sales Industries: Medical Practices Note: This posting contains the relevant responsibilities and qualifications for the Insurance Reimbursement Specialist role. Apply through the company portal as indicated.
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