Administrative - Reimbursement Specialist (Days) Beverly, MA - eTeam Inc.

Job Description:

This position can be in office, hybrid or remote!

The Overpayment Specialist (OVPS-I) is assigned a group of credit balances and is responsible for accurately and efficiently resolving the open claims. Additionally, this individual will review EOB s, contracts and/or other supporting documentation to determine if payments need to be refunded or if balances can be adjusted in accordance with policies and procedures, including federal, state and local standards, guidelines, and regulations.

1.Work credit balances for any financial class and insurance grouping including Self Pay, Commercial, Federal and State insurance plans.

2. Work and track refunds via refund portal for the states that require live checks.

3. Identify and process credit balances by state (as required) by voiding in the applicable insurance portal, subject to management pre-approval.

4. Appropriately identify, address, submit and process credit balance adjustments.

5. Understand and interpret Explanation of Benefits (EOB)/Remittances.

6. Responsible for reviewing and addressing incoming mail correspondence.

7. Effectively communicate and collaborate with all levels of staff/management and other internal departments.

8. Complete and maintain facility reports on a regular basis and reviews for any issues.

9. Answer phone calls from patients, insurance companies and collections agencies and manage refund requests according to process and procedures.

10. Follow up on returned/voided checks.

11. Meet 30-day credit review expectation and clearly document all claim follow up/activity within the billing system.

12. Maintain expected daily/weekly productivity by completing work assignments and taking proper actions to resolve open credit balances.

13. Provide coverage for other Overpayment Specialists when necessary.

14. Gain knowledge of billing requirements by reviewing insurance contracts and understanding billing language and rates. Maintain knowledge of payer guidelines and procedures by staying up to date with insurance updates.

15. Maintain strict confidentiality of patient personal information.

16. Maintain HIPAA compliance.

17. Understand business implications of decisions.

18. Perform other tasks, duties and projects as requested by Management.

SUBMISSION REQUIREMENTS

• Bachelor s degree with a focus in business or healthcare management - REQUIRED
• 2 years experience in accounts receivable or equivalent work experience with medical insurance providers - REQUIRED
• Dialysis or healthcare experience- REQUIRED
• Proficiency in Microsoft Office Suite- REQUIRED
• Knowledge of Excel, PivotTable and VLOOKUP- REQUIRED

Interview expectations.

• • Interviews are conducted via TEAMs and camera must be turned on at all times.
  • Interview may be with more than one Supervisor/Manager