Hybrid Reimbursement Specialist bei OrthoIllinois

Job Purpose:

The Reimbursement Specialist is responsible for reviewing direct and indirect patient and insurance payments for posting into practice management software, researching credit accounts and reconciling payment activity.  

Primary Duties and Responsibilities:

• Posts insurance, patient payments, and adjustments from electronic ERAs, external websites and/or bank lockbox

• Performs necessary contractual/patient responsibility adjustments on accounts according to explanation of benefits and department procedures

• Performs complex calculations to arrive at the correct patient responsibility adjustments

• Reviews ERAs/EOBs/daily correspondence (denials/underpaids/overpaids) to determine appropriate action. Corrects errors and re-files or routes to applicable department for appropriate action

• Routes no pay claims and accounts needing review to appropriate department

• Reconciles outstanding finance deposits with practice management software

• Investigates and initiates refunds to patients and insurance companies

• Initiates and completes troubleshooting activities involving open issues related to unidentified payments, misdirected payments, insurance retractions, and payment discrepancies

• Runs daily batch totals and records on google sheets as directed by finance department; verifies all EFTs and lockbox checks have been posted by month end

• Assists co-workers with inquiries regarding insurance payments and denial.

Competencies: 

• Adaptability: Maintains composure in a fast-paced environment, managing changing priorities and adjusting response appropriately to achieve goals; responds to change with a positive attitude and willingness to learn new ways to accomplish work activities and objectives.

• Attention to Detail: Thoroughness in accomplishing a task through concern for all the areas involved, no matter how small. Monitors and checks work or information and plans and organizes time and resources efficiently.

• Communication: Actively listens, interprets verbal and nonverbal cues, and seeks to understand; presents information clearly both verbally and written with the goal to inform and care for patients; able to adjust presentation as needed for audience.

• Comprehension: Understands and applies detailed instructions and factual information in oral, written and /or diagram form

• Decision Making: Collects and reviews relevant data before acting balancing risk and rewards of options, encourages input from other subject matter experts, able to adjust opinions and recommendations based on new information, and objectively evaluates decisions after they have been made. 

• Initiative / Independence: Works independently with little needed direction taking responsibility for own time and effectiveness.  Proactively recognizes opportunities to contribute, recommends and implements process improvements

• Numerical Skills: Utilizes intermediate mathematical abilities including basic math computations, percentages, ratios, averages and practical application of algebraic math.

• Planning and Organization: Manages a high volume of tasks at one time, prioritizing workload while maintaining a high level of attention to detail

• Professionalism: Shows commitment to quality acting with expertise and integrity; ability to foster collaboration, communicate respectfully, and open to receive feedback.

Organizational Culture:

All OrthoIllinois employees focus on service by putting the mission, vision, and value statements into practice and using the guiding principles of Compassion, Respect, Trust, Integrity, Innovation, Education Fiscal Responsibility, Practice Independence, Accountability, and Empowerment to direct their interactions and decision making.  Employees promote and model the service standards to create lasting impressions, extraordinary moments, exceptional on-stage experiences, and meaningful and compassionate connections.    

Education and Experience Requirements:

• High School Diploma or equivalent

• A minimum of two years of experience in a similar position and/or performing similar tasks

• Previous Medical office or processing claims experience preferred

• Working knowledge of Microsoft and Google Suites 

• Previous experience with EMR systems preferred

Environmental/Working Conditions: 

Working environment is in an office/clinic setting. 

Physical/Mental Demands:  

• Sit or stand for extended periods of time

• Lifting, carrying and/or moving objects up to 20 pounds in a manner consistent with most office environments

• Finger dexterity for typing on a keyboard and using a mouse for extended periods of time.

• Vision (e.g., depth perception, color vision, strong vision up close).

This description is intended to provide only basic guidelines for meeting job requirements.  Responsibilities, knowledge, skills, abilities and working conditions may change as needs evolve