Reimbursement Specialist - Healthcare Appeals, A/R & Payor Collections

The Reimbursement Specialist II ensures that healthcare providers and organizations are appropriately reimbursed for their services. They are responsible for verifying insurance coverage, submitting reimbursement claims, and communicating with insurance companies, patients, and healthcare providers. In addition, they must stay up to date with changes in insurance policies and regulations that may affect reimbursement procedures. Core Duties/Responsibilities: Ensure timely collection of outstanding Accounts Receivable and resolution of billing/claims issues. Research, evaluate, and interpret complex information relative to appeals, payor specific billing policies, and guidelines related to insurance. Manage assigned accounts to ensure timely and appropriate actions are taken to ensure positive cash flow. Required to stay up to date with changes in insurance policies and regulations that may affect reimbursement procedures which include commercial, Medicare, Medicaid and Workers Comp payers. Identify any payments not made in accordance with contracted rates and fee schedules and properly escalate the incorrect payment to the payer. Cross train to provide department coverage. Varying clerical and light accounting work. Additional duties may include data entry, record keeping, participating in projects, and other administrative support as needed. Skills / Requirements Extensive experience with appeals, payor specific billing policies, and guidelines related to insurance and colle