Job Title: Reimbursements Specialist
Reports To: Supervisor- Billing
Location: San Diego
FLSA Status: Non-exempt
The Reimbursement Specialist (RS) reviews the Computer Aided Dispatch (CAD) queue and San Diego Health information Exchange (HIE)for clarity of patient demographics, billing information, supporting documentation, and information surrounding the patient encounter prior to unit dispatch.
The RS will work closely with billing personnel as well to improve quality of data gathering relating to pre-billing authorizations. The RS will also assist patients with appeals to their insurance when claims are denied.
Essential Duties and Responsibilities:
- Use the San Diego Health Information Exchange system to obtain patient demographics and billing information.
- Assist patients through appeals to their insurance for claims that are denied.
- Search other approved systems for additional patient demographics and insurance information to reinforce crew-captured data.
- Search, as applicable or in addition to the Pre-Billing Specialist’s system, the Jaguar billing system for pre-existing account. Provide mechanism to update the account or create a new account as necessary.
- Process customer complaints quickly by receiving, investigating, redirecting or, resolving the issue.
- Convey an attitude of intolerance for unprofessional behavior.
- Develop and sustain excellent working relationships with AMR professionals (e.g., Operations, PBS, Business Development, IT and Finance), as well as with the Company’s clients, payors, consultants, banks and financial intermediaries and government agencies.
- Adhere to all company policies and procedures.
- Adhere to and comply with information systems security. Know and follow Information Systems security policies and procedures, attend Information Systems security training, and report information systems security problems if identified.
- Complete other duties as assigned.
Non-Essential Duties and Responsibilities:
- Communicate a willingness to help others succeed.
- Demonstrate and promote a spirit of teamwork and cooperation.
- Convey and inspire a sense of competence and commitment.
- Use initiative to learn new skills, enhance personal knowledge and improve communications.
- Demonstrate an ability to communicate and work well with others (e.g., customers, facilities, AMR Operations, and payors).
- Seek opportunities to improve the work environment.
- Perform other duties as assigned.
Education/Licensing/Certification: High School diploma or GED required; EMT certification/licensure or medical experience preferred.
2 years’ experience conducting extensive pre-billing processes, including research, resolution and payor contacts, demonstrated ability to function effectively in a high performance, high call volume billing environment. Demonstrated ability to function within multiple payor platforms including San Diego, Medicare, HMO’s, SNF/IFT, private pays and hospital specific payor plans across multiple states.
Experience: Work with computer programs and software preferred; work with general public preferred; experience in medical industry preferred. 2 years’ experience as pre-biller.
Knowledge & Skills:
- Above average knowledge of medical and insurance industry terminology.
- Above average understanding of HIPAA, Sarbanes-Oxley and other critical governmental regulations within one (1) month of hire date.
- Maintain working knowledge of various tools including but not limited to basic Microsoft Office software, QWERTY keyboard use, basic computer function.
- Communicate clearly in English, both verbally and in writing, to convey information distinctly and concisely. Use appropriate grammar and punctuation in written documents.