INTERNAL ONLY - Reimbursement Specialist
JDK Management Company, LP, United States

The Reimbursement Specialist is responsible for timely and accurate billing and collection activities, including interactions with clients/patients, customers and/or third-party payers to maintain accurate records.

This role reports to the Director of Operations. This role does not have direct supervisory responsibilities but will provide daily coaching and guidance to the reimbursement coordinator team.

Responsibilities include the following:

1. Process and submit invoices to clients, customers, VAs or third-party payers for reimbursement. Complete and oversee various billing activities of the Company, including communication with third-party payers/customers and verification of coverage as needed.
2. Oversee the resolution of billing issues such as claim resubmissions or adjustments as well as changes in coverage. Assist in resolving customer complaints and discrepancies.
3. Maintain and oversee accounts receivable aging reports on a regular basis. Drive collection efforts where applicable and review uncollectible balances with management.
4. Oversee month-end processes to ensure various accounts, cylinder transfers and inventory reports are reconciled and complete.
5. Communicate with clients/patients about account status, including the processing of financial hardship forms where applicable.
6. For third-party existing patients, maintain current coverage status information on an ongoing basis. Review and resubmit rejected insurance claims as necessary.
7. Credit client and/or insurance for overpayments and returns of equipment and supplies. Arrange for refunds of overpaid amounts.
8. Maintain current files and billing records, and make changes as needed so that client/patient information on file is accurate and complete.
9. Provide reports on billing activities as requested by Director of Operations.
10. Participate in surveys conducted by authorized inspection agencies.
11. Participate in the Company’s Performance Management program as requested by the Performance Management Coordinator.
12. Participate in Company committees when requested.
13. Pursue continuing education programs appropriate to job responsibilities.
14. Coordinate and provide training to all new and existing reimbursement staff members as necessary.
15. Provide input for performance evaluations of reimbursement staff annually.
16. Review and approve timecards for department staff.
17. Review Accounts Payables and the related process.
18. Process credit card payments and post client cash to account. Ensure all bank deposits are completed daily and cash tie-outs are done in a timely manner.
19. Performs and/or oversees equipment quality control checks.
20. Conduct monthly chart audits for accreditation purposes and review internal 3rd-party chart audits.
21. Complete all third-party insurance company contracts and complete re-credentialing process.
22. Coordinate collaboration between the reimbursement and IT departments to ensure ongoing use of efficient and effective systems. Identify and implement continuous improvements and automation.
23. Perform other duties as assigned by Director of Operations and management.

Requirements

Minimum Qualifications

1. Effective interpersonal, time management and organizational skills.
2. Effective written and oral communication skills with staff and all levels of management.
3. Computer experience to include billing software and Microsoft Office products.
4. High school diploma or equivalent is required.
5. 3+ years of relevant experience is required.
6. Maintains confidentiality within department and externally as required.

Physical Requirements

The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions in this job description:

1. The employee must be able to remain in a stationary position 50% of the time.

2. The employee needs to occasionally move about inside the office to access files and office machinery.

3. Specific vision abilities required by this job include close, distance, and peripheral vision, and the ability to adjust focus.

4. The employee frequently communicates with customers and must be able to exchange accurate information.

Job Rewards and Benefits