Medical Billing Reimbursement Specialist . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
The Medical Billing Reimbursement Specialist in Englewood, Colorado is responsible for day-to-day duties to include: verifying patient benefits, submitting pre-determinations for coverage and payment, filing timely preauthorization and appeal requests, monitoring critical dates, maintains patient confidentiality, organizing documents and information packets, and following up with customer and payer in timely manner to ensure completion and timely resolution of preauthorization, predetermination, and appeal requests. Duties also include: Provides timely and complete information and assistance in response to requests for coverage, coding, and payment assistance from all callers in support of implantable hearing solutions Maintains accurate and timely data for reporting and quality assurance requirements Assists with preparation of timely reports on OMS activities, data needs, and trend analysis as needed and requested Maintains up-to-date information on assigned payer medical policies and contact information Provides notification of medical policy renewal dates and issues to Field Reimbursement Managers Serve as an advocate for individual patient coverage decisions via predeterminations, pre-authorizations, and appeals Maintain direct and ongoing communication with Supervisor regarding status of successes, opportunities, and issues with coverage of implantable hearing solutions Maintains and secures confidential patient documentation in accordance with the company's legal and compliance policies/procedures Identifies key account issues and seeks guidance from Supervisor, Director, and/or Chief Medical Officer to assist in resolving outstanding issues The following skills, knowledge and experience are required for this position unless noted otherwise: At least 3 years prior medical management experience in either a health plan or physician practice A good understanding of the healthcare environment Experience in a call center, health plan, or medical management environment Familiar with coding and benefit coverage Excellent written, verbal, and interpersonal skills Must be a self-starter with strong analytical skills and the ability to effectively solve problems in a timely manner Excellent organizational skills with a strong customer service focused background Ability to multi-task and prioritize tasks Demonstrated team work skills
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