The Reimbursement Specialist is responsible for collecting all necessary reimbursement information, which includes calculating, processing, posting, verifying, and maintaining data and payment reconciliation to account records in Database. Prepares claims and follows up on accounts for timely payments. Coordinates the intake process to maintain departmental policies and procedures to ensure the level of service is appropriate to all clients’ needs. Assist in coordinating all client and insurance reimbursement processes and procedures for RTI’s Insurance reimbursement department.
Accountability 1: Process reimbursement cases
- Ensuring that our customers receive a high level of service
- Ensure that work is conducted as per RTI procedures including the Reimbursement Procedure
- Ensure that Database provides a full representation of the status of all reimbursement cases
Accountability 2: Functions of reimbursement process
- Contacts and communications with insurance companies, clients, doctors and other third parties regarding coverage, co-payment, deductible, medical records and any pertinent information for reconciliation of reimbursement cases
- Verify all required entries are made by Inside Sales Representative in Database and make corrections if necessary
- Verification of clients benefits with insurance company
- Submission of prior approval requests, predetermination requests, medical records requests, questionnaire requests, appeal requests, etc.
- Extensive follow up on all submissions and requests for information
- Perform Quality Assurance on all claims and appeals prior to submission
- Submits claims to insurance companies or other third parties to secure payment
- Processes insurance payments to client accounts in Database system and forwards case to Sales Representative for processing of device shipment and installation
- Generate, analyze and reconcile reports in Database such as “Insurance or patient need to respond (reimburse dept.),” “RTI needs to respond (reimburse dept.),” etc.
- Implement changes in reimbursement requirements
- Works and communicates effectively with other company employees, managers, and departments
Accountability 3: Reporting
- Making recommendations to Director of Reimbursement for payment negotiation requests
- Makes recommendations to Director of Reimbursement for outstanding payments
- Recommends changes in reimbursement requirements to Director of Reimbursement
- Reports delinquent accounts to Director of Reimbursement
- Assist in the development and updating of Policies, Procedures, Forms, etc.
Key Incumbent Requirements: Minimum
- At least 3 years extensive durable medical equipment insurance reimbursement experience
- Exceptional organizational, multitasking and communication skills
- Effective time management skills while working independently with minimal supervision
- Proficient ability and practical knowledge of personal computer use, word processing software, spreadsheet software, accounting software, internet software, Database software additionally, the applicant must demonstrate the ability to learn quickly and proficiently to use company specific software programs and any other handheld or technology tools as required for completing job tasks
- Ability to develop in-depth knowledge about product and services
Limitations and Disclaimer
The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position.
All job requirements are subject to possible modification to reasonably accommodate individuals with disabilities. Some requirements may exclude individuals who pose a direct threat or significant risk to the health and safety of themselves or other employees.
This job description in no way states or implies that these are the only duties to be performed by the employee occupying this position. Employees will be required to follow any other job-related instructions and to perform other job-related duties requested by their supervisor in compliance with Federal and State Laws.
Requirements are representative of minimum levels of knowledge, skills and/or abilities. To perform this job successfully, the employee must possess the abilities or aptitudes to perform each duty proficiently. Continued employment remains on an “at-will” basis.
Restorative Therapies is an equal opportunity/affirmative action employer.
