Reimbursement Specialist
On-siteKnoxville, Tennessee, United States
Job Summary
Analyze daily eligibility reports, verify client commercial insurance coverage, and ensure procedures are covered by individual insurance plans. Enter data accurately into the billing system, update client benefit information, and audit resolution-centered activities to identify and resolve insurance errors, denials, and appeals. Communicate with internal and external sources, including the Insurance Verification Team Leader and billing representatives, to answer coverage questions and recommend solutions. Research discrepancies, handle collections issues, and perform additional duties as assigned by management. Work regular office hours Monday through Friday from 8am to 5pm in Knoxville, Tennessee, utilizing advanced computer skills and knowledge of insurance guidelines including HMO/PPO, Medicare, and Medicaid. Maintain patient confidentiality per HIPAA and adhere to all federal and state billing regulations.
Required Qualifications
- High school diploma or equivalent
- Extensive knowledge of insurance in relation to proper billing, follow-up and verification duties
- Advance use of computer system, software, Excel, Outlook and Microsoft (word processing and spreadsheet application)
- Basic computer skills for email, timekeeping, scanning, and fax machine
- Ability to work well in a team environment and alone
- Ability to triage priorities, delegate tasks if needed, handle conflict in a reasonable fashion and analyze and resolve claims issues and related problems
- Strong written and verbal communication skills
- Possesses effective communication skills for phone contacts with insurance payers to resolve issues and to communicate effectively with others
- Ability to maintain records and prepare reports and correspondence related to the position
- Ability to work directly with upper leadership regarding claims issues and resolutions
- Possesses flexibility to work overtime as dictated by department/organization needs
- Possesses problem-solving skills to research and resolve discrepancies, denials, appeals, collections
- Strong ability to think outside the box
- Has the ability to work in a high stress/demanding environment
- Must be able to lift 50 lbs
Desired Qualifications
- Knowledge of Centricity
- Knowledge of insurance guidelines including HMO/PPO, Commercial, Medicare, Medicare Advantage, TN Care's, Medicaid and Private Pay
- Bilingual
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