Reimbursement Specialist

Support PPMW’s Revenue Cycle activities by performing all billing and collection functions for selected payer groups/financial classes, including posting and follow up on all outstanding Accounts Receivables (A/R). Provide feedback as appropriate to improve affiliate performance and increase reimbursement. Active participant in meetings with affiliate(s). Complete billing special projects as assigned. 

• Conduct appropriate claim follow-up on all open A/R to ensure prompt adjudication.
• Perform daily ERA, EOB, and patient payment posting.
• Submit daily electronic and paper claim files, and correct all claim and charge review edits, warnings and errors; run statement files; and download ERAs/EOBs as needed.
• Review and monitor clearinghouse claim errors and global payer rejections for possible system edits or payer updates.
• Daily review of billing work queues.
• Credit balance review and processing.
• Insurance benefit verification.
• Analyze payer denial trends and payer coding requirements to ensure payment of claims.
• Ensure month-end activities are completed in a timely manner and that month-end reconciliation is accurately completed.
• Ensure the affiliate’s claim KPIs are satisfied.
• Participate in Revenue Cycle Team meetings/conference calls, and provide the necessary reporting, feedback, and training required to improve processes.
• Serve as an active agent on the billing line.
• Attend PPMW and PPFA training as well as other assigned training to improve knowledge base and claim efficiency.
• Follow up on denied claims with payers.
• Patient statement processing.
• Grant billing.
• Complete special projects as needed.
• Other responsibilities as assigned.

• Bachelors degree preferred, high school diploma or equivalent required
• Three or more years’ experience in medical billing and/or Accounts Receivable
• Epic experience preferred
• Ability to work independently, prioritize work, and communicate effectively.
• Experience with patient billing and collections.
• Ability to handle confidential materials that relate to a variety of individuals.
• Ability to thrive in a fast-paced environment.
• Superb attention to detail.
• Strong problem-solving skills.
• Ability to work independently, including handling multiple projects/tasks simultaneously.
• Access to secure, reliable Internet and utilities.