<p>Account Reimbursement Specialist II</p> <p>Job Summary: The Account Reimbursement Specialist II demonstrates a thorough understanding of medical office billing-related functions. This role will closely monitor and analyze payor denial trends, perform claim corrections, and perform timely claim follow-up by submitting appeals and claim reconsiderations to ensure maximum payor reimbursement. This role is vital to the overall financial success for the organization.</p> <p>(This is a full-time position that will support RCM team Monday - Friday 8 am to 5 pm).</p> <p>Primary Job Responsibilities:</p> <ul> <li>Ability to perform all responsibilities of ARS I position. </li><li>Acts as point of contact for assigned department(s) for incoming questions regarding third-party billing requirements, denials, and patient-related billing inquiries. </li><li>Coordinates with RCM team partners responsible for charge capture, coding, reimbursement and/or insurance verification to identify and resolve issues impacting billing and collections. </li><li>Pursues timely collection of insurance claim payments using thorough follow-up efforts appropriate for each payor type (including denials, appeals, exceptions, exclusions). </li><li>Review and interpret insurance explanation of benefits (EOBs) to ensure correct claim reconciliation. </li><li>Filing appeals when appropriate to obtain maximum payor reimbursement. </li><li>Analyzes trends in under/overpayments and payment denials and works collaboratively to develop process improvements meant to improve RCM operations and reduce costs. </li><li>Coordinate medical records requests; process all insurance and patient correspondence to ensure compliance with all relative reporting and data collection regulations. </li><li>Perform patient and insurance payor outreach to research and resolve payment-related inquiries for Athena patient cases. </li><li>Work collaboratively with clinic managers and other RCM department staff to improve processes and procedures. </li><li>Participate in department workgroups providing feedback and education on claims activities (payer denials, system issues, etc). </li><li>Additional duties as assigned. </li></ul> <p>Requirements:</p> <ul> <li>Minimum of three (3) years of complex claim follow-up experience in a physician office, hospital, ambulatory surgery center or centralized medical business office. </li><li>Knowledge of HMO/PPO, Medicare, Medicaid, and other payor regulations, payment guidelines, and policies. </li><li>Knowledge of medical terminology, ICD-10, and CPT codes. </li><li>Excellent verbal communication skills. </li><li>Excellent computer skills; familiarity with Microsoft Word & Excel. </li><li>Experience with AthenaHealth EMR is a plus. </li><li>Ability to manage time and organize daily schedule to meet productivity and accuracy standards. </li><li>Experience interpreting payor explanation of benefits. </li><li>Excellent verbal communication skills and strong customer-service background. </li></ul> <p>Education and Certifications</p> <ul> <li>High school diploma or equivalent required. </li><li>Associate degree in business, healthcare administration or related field highly preferred. </li></ul> <p>Physical Requirements</p> <ul> <li>Work consistently requires walking, standing, sitting, lifting, reaching, stooping, bending, pushing, and pulling. </li><li>Must be able to lift and support weight of 35 pounds. </li><li>Ability to concentrate on details. </li><li>Use of computer for long periods of time. </li></ul>