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Reimbursement Counselor
Reimbursement CounselorMMC Group • San Bruno, CA, US
Reimbursement Counselor

Reimbursement Counselor

MMC Group • San Bruno, CA, US
[job_card.30_days_ago]
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  • [job_card.full_time]
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Reimbursement Coordinator

San Bruno, CA

19.50 / HR

Hours : 7 : 00 AM - 4 : 00 PM Monday - Friday

POSITION SUMMARY :

Under the general supervision of the Reimbursement Supervisor / Manager, is responsible for various reimbursement functions, including but not limited to accurate and timely claim submission, claim status, collection activity, appeals, payment posting, and / or refunds, until accounts receivable issues are properly resolved.

PRIMARY DUTIES AND RESPONSIBILITIES :

  • Completing / Conducting Benefit Investigations
  • Completing Prior Authorizations and determining best approach for a PA process
  • Transferring Cases to Specialty Pharmacies
  • Follow-up Calls to Insurances
  • Conducting Alternative Coverage searches
  • Creating letters of medical necessity
  • Drafting appeal letters
  • Collects and reviews all patient insurance benefit information, to the degree authorized by the SOP of the program
  • Provides assistance to physician office staff and patients to complete and submit all necessary insurance forms and program applications
  • Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payors. Researches and resolves any electronic claim denials
  • Researches and resolves any claim denials or underpayment of claims
  • Effectively utilizes various means for collections, including but not limited to phone, fax, mail, and online methods
  • Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly
  • Maintains frequent phone contact with provider representatives, third party customer service representatives, pharmacy staff, and case managers
  • Reports any reimbursement trends / delays to supervisor (, claim denials, pricing errors, payments, etc.)
  • Processes any necessary insurance / patient correspondence
  • Provides all necessary documentation required to expedite payments. This includes demographic, authorization / referrals, National Provider Identification (NPI) number, and referring physicians
  • Coordinates with inter-departmental associates to obtain appropriate medical records as they relate to the reimbursement process
  • Maintains confidentiality in regards to patient account status and the financial affairs of clinic / corporation
  • Communicates effectively to payors and / or claims clearinghouse to ensure accurate and timely electronically filed claims
  • Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercises judgment within defined standard operating procedures to determine appropriate action
  • Typically receives little instruction on day-to-day work, general instructions on new assignments
  • Performs related duties as assigned

MINIMUM SKILLS, KNOWLEDGE AND ABILITY REQUIREMENTS :

  • Must have recently experience with Health Insurance
  • Ability to communicate effectively both orally and in writing
  • Ability to build productive internal / external working relationships
  • Strong interpersonal skills
  • Strong negotiating skills
  • Strong mathematical skills
  • Strong organizational skills; attention to detail
  • General knowledge of accounting principles, pharmacy operations, and medical claims
  • General knowledge of HCPCS, CPT, ICD-9 and ICD-10 coding preferred
  • Global understanding of commercial and government payers preferred
  • Ability to proficiently use Microsoft Excel, Outlook and Word
  • Is developing professional expertise; applies company policies and procedures to resolve a variety of issues
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Reimbursement Counselor • San Bruno, CA, US

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