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U.S. Renal Care · 2 days ago

Reimbursement Representative

Plano, TX

Full-time

Onsite

Entry Level

2+ years exp

U.S. Renal Care is a leader in the dialysis industry, emphasizing diversity and inclusion in its workforce. The Reimbursement Representative is responsible for reconciling and reviewing Medicare/Commercial patient balances in accordance with company policies, ensuring timely claims payment and resolving any discrepancies.

BiotechnologyHealth CareMedical

Responsibilities

Reviews EOB/EOMB's for proper reimbursement

Resolves electronic claim rejections and Explanation of Benefits denials in a timely manner

Reviews and researches insurance correspondence and makes necessary corrections to ensure claims payment

Follows up on unpaid/unresolved account balances, including claims rejected electronically, EOB denial and working A/R aging reports as directed. Provides insurance carriers with requested information to facilitate payment

Regularly contacts Medicare, Medicaid and /or Commercial payors for resolution to claims not paid or claims not paid according to plan benefits

Performs claim appeals as required

Assists with credit balance resolution

Completes re-bill request as necessary to facilitate timely and proper claims payment

Follows up on unresolved account balances including RTP's

Prepares adjustment and write-off requests as necessary

Performs other duties and responsibilities as required or assigned

Qualification

Medical billing softwareCPTICD-9HCPCS codingMedical terminologyMicrosoft OutlookMicrosoft WordMicrosoft ExcelConfidentiality (HIPAA)Communication skillsProblem-solving skills