We welcome you to join Philips Sleep and Respiratory Care (SRC) business as a Reimbursement Specialist in our Plymouth, MN location.
As the Reimbursement Specialist, you will be responsible for the accurate and efficient follow up and resolution of outstanding claims from insurance carriers, third party agencies and patients.
You will also coordinate, document, and communicate with health insurance representatives regarding proper insurance payments in accordance with policies and procedures, current federal, state and local and standards, guidelines, and regulations. The Reimbursement Specialist will assist the leadership on key reimbursement projects
You are responsible for
- Responsible for accurate and timely collecting of billed and unpaid DME claims related to Commercial, Federal and State insurance plans and private pay accounts; monitor and minimize aged accounts receivables; ensure follow up on claims is within payer turn-around-time standards.
- Obtain and track claim status via phone and online portals.
- Monitor, take action and respond to claims related correspondence.
- Compose and follow up on claims appeals within specified payer timelines and protocals.
- 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.
- Updates claims related to change of insurance
- Performs other duties as requested by supervisor or manager.
- Reviews and release rental agreement hold.
- 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.
Processes, Procedures and Systems (10%)
- Reviews, understands and follows department policies, Standard Operating Procedures (SOPs) and job aides.
- Notifies Supervisor and Manager of any defects or enhancement opportunities for SOPs and job aides.
- Assists with annual review of SOP’s and job aides.
Mentoring and Special Projects (10%)
- Assists peers in answering processing questions and assists in training new hires
- Assumes responsibility for reimbursement related special tasks or assignments
- Serves as subject matter expert in the absence of the supervisor
- Collaborates with external and internal team members and customers to create a positive experience for customers and minimizes days sales outstanding (DSO) and denials and maximizes cash collections
To succeed in this role, you should have the following skills and experience
- Bachelor’s degree or equivalent work experience or combination of secondary education
- Work experience in a healthcare related setting
- 4+years of direct work experience related to medical claims billing/collections, insurance, appeals, authorizations
- Durable Medical Equipment (DME) claim processing experience preferred
- Demonstrated superior customer service skills
- Proven excellent verbal and written communication skills
- Strong computer skills, including word processing and spreadsheet software
Physical Requirements of the Position:
Candidate must be able to sit at a desk in front of a personal computer (PC) monitor for long periods of time.
Position requires incumbent to use a PC, telephone, and basic office equipment. This position requires the candidate have the ability to conduct telephone conversations, read medical and insurance information and communicate clearly with all internal and external customers.
Candidate must be able to sit at a desk in front of a personal computer (PC) monitor for long periods.
Position requires incumbent to use a PC, telephone, and basic office equipment. This position requires the candidate have the ability to conduct telephone conversations, read medical and insurance information and communicate clearly with all internal and external customers
You are part of
A company comprised of the best and brightest people working to improve the lives of 3 billion people a year by 2030. A culture of diverse people and ideas who believe there’s always a way to make life better. A greater purpose that means we come to work thinking about what we can to do to help prevent, diagnose and treat life’s most threatening diseases, solve the most challenging issues facing health systems, and find new ways to bring access to care to those who need it most.
In return, we offer you
We offer you the opportunity to grow within the organization and Philips – develop strong partnerships across Procurement, Head of Manufacturing, Q&R, Business Unit’s, and Group Functions on various projects and initiatives to drive our products to our customers and be a part of saving people’s lives every day.
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. Learn more by watching this video
Find out more info about Philips at www.philips.com/na/careers
It is the policy of Philips to provide equal employment and advancement opportunities to all colleagues and applicants for employment without regard to race, color, ethnicity, religion, gender, pregnancy/childbirth, age, national origin, sexual orientation, gender identity or expression, disability or perceived disability, genetic information, citizenship, veteran or military status or a person’s relationship or association with a protected veteran, including spouses and other family members, marital or domestic partner status, or any other category protected by federal, state and/or local laws.
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.
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