The Reimbursement Specialist is responsible for the accurate and efficient billing and collecting of payments from insurance carriers, third party agencies and patients. The Reimbursement specialists will coordinate, document, and communicate with health insurance representatives and patients in regards to proper insurance payments in accordance with policies and procedures, and current federal, state and local and standards, guidelines, and regulations. This role will work the hours of Monday through Friday, 8am to 5pm.
You are responsible for:
- Responsible for accurate billing and collecting of revenue for financial classes including Commercial, Federal and State insurance plans and private pay accounts.
- Obtain and track claim status via phone and online portals.
- Compose and follow up on claims appeals
- Appropriately identify, address, submit or process adjustments, overpayments, and outstanding balances.
- Review and respond to payment information associated with Explanation of Benefits or Remittance Advice documents.
- Build relationships with insurance carriers and representatives.
- Allocating coinsurance and deductible appropriately within the database.
- Responsible for reviewing and addressing incoming mail correspondence.
- Communicating with patients regarding outstanding balances.
- Communicate and collaborate with the internal departments.
- Maintains strict confidentiality of patient personal information.
- Maintains HIPPA compliance.
- Understands business implications of decisions.
- Performs other duties as requested by supervisor or manager.
- Reviews, understands and follows department policies, Standard Operating Procedures and job aides.
- Notifies Supervisor and Manager of any defects or enhancement opportunities for SOP’s and job aides.
- Assists with annual review of SOP’s and job aides.
You are a part of:
To succeed in this role, you should have the following skills and experience:
- Bachelor’s degree preferred or equivalent work experience
- Minimum two years’ experience in insurance, reimbursement or healthcare related industry.
- Knowledge of healthcare compliance and regulatory reimbursement and insurance-related requirements
- Working knowledge of medical terminology and HCPCS and ICD-10 codes
- Excellent communication skills, both verbal and written
- Demonstrated superior customer service skills
- Process and detail oriented
- Strong computer skills, with advanced knowledge of word processing, spreadsheet, presentation and database software, such as Microsoft Office.
- Exceptional analytical and problem solving skills in complex situations
- Ability to work independently and as part of a team
- Strong skills in fostering cross-functional working relationships
In return, we offer you
Sharpen your talents with new challenges in our dynamic organization. As a market-driven company, we’re used to listening to our customers & apply the same thinking to our employees. We offer a competitive salary, outstanding benefits and flexibility in a career with a positive and supportive atmosphere in which to develop your talents further.
Why should you join Philips?
Working at Philips is more than a job. It’s a calling to create a healthier society through meaningful work, focused on improving 3 billion lives a year by delivering innovative solutions across the health continuum. Our people experience a variety of unexpected moments when their lives and careers come together in meaningful ways.
To find out more about what it’s like working for Philips at a personal level, visit the Working at Philips page on our career website, where you can read stories from our employee blog. Once there, you can also learn about our recruitment process, or find answers to some of the frequently asked questions.
It is the policy of Philips to provide equal employment and advancement opportunities to all colleagues and applicants for employment without regard to age, color, citizenship, disability or perceived disability, ethnicity, gender, gender identity or expression, genetic information, marital or domestic partner status, military or veteran status, national origin, pregnancy/childbirth, race, religion, sexual orientation, or any other category protected by federal, state and/or local laws. Philips is an equal employment opportunity and affirmative action employer Disability/Veteran.
As an equal opportunity employer, Philips is committed to a diverse workforce. In order to ensure reasonable accommodation for individuals protected by Section 503 of the Rehabilitation Act of 1973, the Vietnam Veterans' Readjustment Act of 1974, and Title I of the Americans with Disabilities Act of 1990, applicants that require accommodation in the job application process may contact 888-367-7223, option 5, for assistance.