Principal Duties and Responsibilities (Essential Functions):
* Retrieve and properly identify any document received from Revenue Cycle Management (RCM) system
* Update tracking and billing systems accordingly
* Perform internal and external data, files, or medical chart reviews to assure that codes billed are appropriate and supported by documentation in the records and comply with Centers for Medicare and Medicaid Services (CMS) guidelines and medical policies
* Complete, review, and research any deficiency to ensure that any deficiency is properly addressed
* Consult with physicians / clinicians and their staff (if acceptable within the Region), as needed, on documentation issues, and other regulatory issues as they arise
* Develop and manage relationships with colleagues in a professional - Responsible for conducting special projects, which may include reconciling and reviewing medical necessity, as necessary. Special projects may require spreadsheet development as well as reports that summarize outcome of special projects
* Report anomalies and new trends immediately to Supervisor for additional input.
Reimbursement Specialist
* Prepare complex claims reimbursement submissions in a managed care environment
* Assess complex claims to determine risk of denial, audit, and/or retraction
* Serve as an advocate and resource to clinic administration in the areas of reimbursement and managed care
* Conduct analytical research and provide expertise on items; such as; pricing, reimbursement, and claim appeals process
* Maintain and support relationships with customers and insurance/managed care organizations to ensure a successful reimbursement program
* Work closely with field staff and may provide training on relevant reimbursement issues
* Process complex claims with a high degree of accuracy
We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to
HR@insightglobal.com.
To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy:
https://insightglobal.com/workforce-privacy-policy/ .
Benefit packages for this role will start on the 31st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.