The Reimbursement Specialist II is responsible for billing, collections, payment posting, appeals, data entry, phone calls, inquires, and other functions as assigned.

·         Ability to appeal denied and deficient claims.

·         Ability to spell, have good grammar, and can write an appeal letter.

·         Ability to read & understand an EOB

·         Participates in educational activities and reports needed information to Collections Manager.

·         Contact and follow up with insurance carriers on denials, file reconsideration requests, formal appeals, and negotiations

·         Ability to organize and manage multiple priorities commitment to company values

·         Aggressive follow up in collecting from insurance companies

·         Skill in fast data entry and accuracy.

·         High level of discretional, interpersonal skills.

·         Tactfulness in dealing with patients, co-workers, and other professional offices.

·         Knowledge of medical terminology

·         Interact with external/internal customers as necessary to resolve problems and expedite payments

·         Obtain status of outstanding claims

·         Problem Solving/Troubleshooting

·         Follow-up on outstanding AR balances assigned by supervisor or manager

·         Ensure timely and accurate processing of re-bills to the appropriate insurance companies

·         Provide detailed information regarding problem payors to management

·         Submit appeals based on denials from payor

·         Provide suggestions for solutions to management

·         Other duties as assigned

·         High School degree or equivalent

·         Minimum of 8-year Medical Collections Experience Required

·         Knowledge of CPT, and/or ICD-10

·         Knowledge of legal and regulatory government provisions

·         Knowledge of laws that regulates communication and privacy act. HIPAA laws and understanding of the application of all above

·         Must maintain professional appearance.

·         Ability to be at work on a regular and consistent basis

This position will spend long hours sitting and using office equipment and computers. The position may also entail light lifting of supplies and materials occasionally, up to and including 20 pounds in addition to reaching, stooping, standing, and walking. This position requires the ability to talk, hear, compare, compute, compile, copy, analyze, coordinate, synthesize, negotiate and communicate. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.

Standard office working environment that may be busy and noisy at times.