Reimbursement Specialist - Healthcare jobs in Kansas

Description

Job Summary:

We are seeking a detail-oriented and organized Reimbursement Specialist to join our orthopedic hospital's administrative team. The Reimbursement Specialist plays a crucial role in ensuring accurate and timely reimbursement for medical procedures by confirming patient insurance coverage, determining deductibles, and providing estimates for medical expenses. The ideal candidate will possess strong analytical skills, a deep understanding of medical insurance billing processes, and the ability to navigate complex insurance policies.

Responsibilities:

• Verify Insurance Coverage: Confirm patient insurance information, including eligibility, coverage limitations, and benefits related to orthopedic procedures.
• Determine Deductibles: Investigate patient insurance policies to determine the presence and amount of deductibles for orthopedic procedures and communicate the information to relevant departments.
• Estimate Procedure Costs: Utilize knowledge of insurance coverage, fee schedules, and medical coding to calculate and provide accurate estimates of patient out-of-pocket expenses for orthopedic procedures.
• Collaborate with Administrative Team: Work closely with the administrative team to ensure accurate documentation of procedures and assist in obtaining necessary medical records for insurance reimbursement.
• Liaise with Insurance Companies: Communicate with insurance companies to verify claim statuses, resolve billing issues, and facilitate reimbursement for orthopedic procedures.
• Stay Updated on Reimbursement Guidelines: Continuously monitor and stay informed about changes in insurance policies, reimbursement guidelines, and medical coding practices to ensure compliance and accurate reimbursement.
• Maintain Records: Accurately document and maintain records of insurance verification, estimates, and reimbursement activities in accordance with hospital policies and regulations.
• Provide Support to Billing Department: Collaborate with the billing department to resolve insurance-related issues, ensure accurate billing, and assist in claims processing. 

Requirements

• Education: High school diploma or equivalent (Bachelor's degree in healthcare administration or related field preferred).
• Experience: Minimum of 2 years of experience in medical billing, insurance verification, or related roles, preferably in an orthopedic or hospital setting.
• Knowledge of Medical Billing and Coding: Strong understanding of medical billing procedures, insurance coding (ICD-10, CPT, HCPCS), and reimbursement guidelines.
• Insurance Knowledge: Familiarity with different insurance plans, policies, and procedures, including deductibles, co-pays, and coverage limitations.
• Analytical Skills: Ability to analyze insurance policies, calculate costs, and provide accurate estimates for orthopedic procedures.
• Attention to Detail: Meticulous attention to detail to ensure accurate insurance verification, billing, and reimbursement processes.
• Organizational Skills: Ability to prioritize tasks, manage multiple assignments simultaneously, and meet deadlines in a fast-paced environment.
• Problem-Solving Abilities: Strong analytical and problem-solving skills to resolve insurance-related issues and discrepancies.
• Technical Skills: Proficiency in using medical billing software, electronic health record (EHR) systems, and Microsoft Office applications.
• Compliance Knowledge: Familiarity with healthcare compliance regulations, such as HIPAA and billing guidelines set by insurance companies and government payers.