Reimbursement Specialist – Home Health Exp Preferred

This is a fully remote position, open to applicants in Texas.

📋 Description

• Conduct investigations into insurance benefits for new referrals.

• Assign and pursue collections across various payers.

• Request authorizations and submit claims as necessary.

• Interpret patient insurance, prescriptions, and other health-related documents.

• Perform medical insurance verifications and investigations for both commercial and government payors.

• Liaise with insurance companies, patients, providers, and prescribers to coordinate reimbursement and access solutions.

• Review unpaid accounts, assess their status, and take appropriate actions to ensure payment.

• Examine claims for compliance and completeness prior to submission.

• Investigate alternative funding options to alleviate patients' financial burdens.

• Manage high call volumes effectively.

• Coordinate care with both internal and external departments.

• Uphold the confidentiality of sensitive information.

• Maintain consistent attendance and demonstrate flexibility to meet departmental needs.

• Adhere to relevant regulations, policies, procedures, and standards.

• Engage in continuous quality improvement initiatives.

• Carry out additional duties as assigned.

⛳️ Requirements

• A high school diploma or equivalent is mandatory.

• An undergraduate degree is preferred.

• A minimum of 5 years of experience in healthcare collections/billing is preferred.

• Strong knowledge of hospice billing regulations, including Medicare, Medicaid, and commercial policies.

• Ability to read and interpret Explanation of Benefits (EOBs), remittances, and denial codes.

• Effective strategies for payer follow-up and escalation.

• Proficiency in resolving claim holds, rejections, and denials.

• Skill in identifying trends in denials or delays.

• Conduct root-cause analysis to avert recurring issues.

• High attention to detail to ensure the submission of clean claims.

• Proficient in working with Accounts Receivable (AR) reports and aging summaries accurately.

• Ability to communicate clearly and professionally with internal teams and payer representatives.

• Capability to explain payer issues in clear, understandable terms.

• Quick and accurate alphanumeric data entry skills are essential.

• Computer proficiency, particularly in MS Office and web-enabled applications, is strongly preferred.

• Customer service skills are required.

• Ability to plan and organize work effectively to ensure task completion.

• Capacity to meet productivity requirements consistently.

• Self-starter with outstanding organizational skills and follow-through.

• Ability to work independently and collaboratively within a team environment.

• Must comply with Medicare, Medicaid, and HIPAA regulations and requirements.

🏝️ Benefits

• Medical, Dental, and Vision Benefits.

• Opportunities for Continued Education.

• Paid Time Off (PTO) plan.

• Retirement Planning options.

• Life Insurance coverage.

• Employee discounts.

• Flexible remote work schedule.