Reimbursement Specialist

Primary City/State:

Arizona, Arizona

Department Name:

Admin-HME

Work Shift:

Day

Job Category:

Administrative Services

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POSITION SUMMARY
This position works as a member of a team to ensure reimbursement for services in a timely and accurate manner. Responsible for obtaining and maintaining all supporting documents required by government agencies and other insurance companies for appropriate reimbursement of home medical equipment. Provides administrative services and assistance. Coordinates processes for an assigned area such as but not limited to claims, transitions, loan closets, selection, validation or billing.
CORE FUNCTIONS
1. Obtains and maintains physician orders, authorizations, Certificates of Medical Necessity (CMN) and other supporting documents to ensure reimbursement from government agencies and insurance companies for medical equipment services.
2. Attends in-service education and training on policy, procedure, and work related material such as ADR (Medicare - Additional Documentation Request).
3. Acts as an internal resource for qualifying criteria, payment limitations and required documentation. Provides assistance to patient financial services regarding accurate patient account charges. Verifies the accuracy of required documentation. Examines and tracks all orders to ensure proper billing. Verify balances and receipts for all form of payments then completing an End of Day report.
4. Schedules and maintains CMNs and physician's orders for timely delivery and enters completed order into billing system for reimbursement.
5. Research/responds to overdue/delinquent accounts and follows up by mail and/or phone to resolve in a timely manner.
6. Research customer accounts thoroughly and documents appropriately, processes adjustments when services are non-covered or been denied.
7. This position is responsible for Certificates of Medical Necessity, physician orders and documentation for home medical equipment. The incumbent makes final independent decisions on the accuracy of the documentation.
MINIMUM QUALIFICATIONS
High school diploma/GED or equivalent working knowledge.
Skills and abilities normally gained with 2-3 years of experience in patient accounts, pharmacy or equipment intake. This position requires a thorough understanding of regulatory and accreditation requirements of medical equipment and infusion medications for government and third party agencies to ensure compliance and appropriate reimbursement. Requires effective interpersonal skills, with ability to provide effective customer service. Demonstrated organizational and problem solving skills are needed. Ability to keep detailed records regarding equipment and medical records. Ability to communicate effectively. Able to prioritize and organize daily work. Demonstrated ability to use and develop proficiency with computers and office software.
PREFERRED QUALIFICATIONS

1-2 years of experience in clerical, customer relations and/or customer service departments is preferred.
Additional related education and/or experience preferred.

EEO Statement:

EEO/Female/Minority/Disability/Veterans

Our organization supports a drug-free work environment.

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