The Onyx Group - Medical Reimbursement Specialist

Position Overview:

Our healthcare organization is seeking a Medical Reimbursement Specialist who is motivated and hungry to learn. The ideal candidate will have a background in medical billing or be excited to learn. This individual will perform high-volume billing functions and administrative tasks.

This position is responsible for following up on unpaid claims. You must be comfortable working in a fast-paced environment.

Responsibilities: 

• • Responsible for the reporting, monitoring, analysis, and follow-up of denials
  • Identifies whether a denial can be appealed or if a write-off is required.
  • Provides appropriate denial information to root cause areas to ensure systems, processes and measures of effectiveness (e.g., remediation action plans) are created and implemented to reduce/eliminate denials.
  • Review and research claims in which a denial of payment has been received from the payer.
  • Identifies the root cause of the denial and addresses the denial issue with the appropriate department.
  • Reports issues and trends to team members and management and works collaboratively to develop solutions.
  • Demonstrates problem-solving skills related to denial analysis.
  • Provides direction to members of the team, serves as a resource for questions.
  • Completes follow-up with patients, as necessary (contact may involve dealing with an angry or upset patient).
  • Utilizes desk phone, clearinghouse, etc. to submit claims, very insurance, work claim denials, and fix rejections. 
• Reads and interprets insurance explanation of benefits.
  • Timely follow up on insurance claim denials, meets deadlines, and utilizes monthly aging report to follow up on unpaid claims aged over 30 days. 
• Verify patient benefits and updates the patient's account accordingly.

• Responds to inquiries from insurance companies, patients, and providers.
  • Meets with Billing Coordinator and team on a monthly basis to discuss and resolve reimbursement issues or billing obstacles. Participates in educational activities and attends department meetings. 
  • Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations; also conducts self in accordance with the Onyx employee handbook.
  • Actively demonstrates an overall desire to practice the Conscious Leadership through humility and exemplify a servant's attitude towards others in the department, company, and patient population. Works to maintain integrity and excellence in every area of the job description and show initiative towards others by practicing conscious leadership in the role. 

Education:  

• High school diploma or GED required with experience in denials management in a healthcare business office environment.
• eCW and/or Waystar experience is preferred, but not required.
• The ability to communicate and work with payers to get claims resolved and paid accurately is required.
• Demonstrates in-depth knowledge and experience in the following is required:
  • Insurance denials management
  • Medical terminology
  • Medical insurance regulations and policies
  • Insurance payment policies/guidelines

Skills/Experience:

• Knowledge of medical billing/collection practices, basic medical coding, and medical office operating procedures and practices. (Preferred but not required)  
• Must have strong attention to detail and customer service skills 
• Must be able to multi-task and work efficiently in a fast-paced work environment 
• Strong Microsoft Office and computer skills 
• Comfortable making outgoing phone calls and receiving incoming phone calls on a multi-line telephone system  
• A strong communicator with a pleasant and helpful manner, as well as the ability to establish and maintain effective working relationships with patients, team members, and Providers.
• The Providers that we support code their own visits, so a coding certificate is not required. 

Environmental/Working Conditions:  

Normal office environment. Occasional overtime may be required and/or hours may be shortened as business needs dictate.

Physical Demands:  

Requires sitting and standing associated with a normal office environment. Manual dexterity needed for using a calculator and computer keyboard. This description is intended to provide only basic guidelines for meeting job requirements. Working conditions, skills and responsibilities may change as needs evolve. 

The Onyx Group is an equal opportunity employer.