Reimbursement Specialist

Performs a variety of accounts receivable activities and related tasks to maximize reimbursement from each claim. This role is responsible for navigating the electronic medical record (EMR) and billing systems to obtain, produce, and transmit records required by the applicable insurance carrier or third party. The position requires understanding of explanation of benefits (EOBs), the ability to address denials and correspondence appropriately, and clear, concise documentation.

Responsibilities

• Understand and comply with all governmental, regulatory, company billing/AR, and compliance regulations and policies assigned by payers.
• Analyze EOBs and construct responses to insurance carriers based on claim adjudication.
• Follow up with payers and other appropriate parties to collect open balances in a timely manner and ensure compliance with payer guidelines.
• Identify and report payer issues regarding rejection trends, denial trends, or payment changes.
• Communicate specific payer information to appropriate departments.
• Address denials and zero payments by providing requested documentation or referring claims to billing for corrections.
• Follow up on pending accounts until the account is settled.
• Use office equipment and software applications to facilitate claim finalization.

MPOWERHealth supports independent musculoskeletal physicians with clinical services, back-office solutions, and advanced technology to improve healthcare operations.