Healthcare

Specialist, Reimbursement

San Antonio, TXOnsiteFull TimePosted 6 days ago

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Required skills

Medical Collections
Claims Appeals
EOB
CPT
ICD-10
HIPAA
Data Entry
AR balances
re-bills

Nice to have

Collections Manager
negotiations

Role summary

MPOWERHealth is seeking a Specialist, Reimbursement to manage denied and deficient claims, file appeals, and follow up with insurance carriers. This role requires strong medical collections experience, knowledge of CPT, ICD-10, HIPAA, and excellent data entry and communication skills. The specialist will interact with customers to expedite payments, track outstanding AR balances, and provide detailed information to management regarding payment issues. A minimum of 2 years of medical collections experience and a High School Diploma are required.

Overview

About MPOWERHealth:

For over a decade, MPOWERHealth has supported the independent musculoskeletal physician with best-in-class clinical services, back-office solutions, and advanced technology. We pride ourselves on being a partner that offers foresight to customers. We simplify what’s complex, and we help them find a better way. Our best-in-class analytics coupled with industry-leading expertise make MPOWERHealth the company our customers can rely on no matter what lies ahead.

Benefits:

Multiple medical plan options
Health Savings Account with company contributions
Dental & vision coverage for you and your dependents
401k with Company match
Vacation, sick time & Company paid holidays
Company wellbeing program with health insurance incentives

Responsibilities

ESSENTIAL WORK SKILLS/KNOWLEDGE & ABILITIES:

Ability to appeal denied and deficient claims.
Ability to spell, have good grammar, and can write an appeal letter.
Ability to read & understand an EOB
Participates in educational activities and reports needed information to Collections Manager.
Contact and follow up with insurance carriers on denials, file reconsideration requests, formal appeals and negotiations
Ability to organize and manage multiple priorities commitment to company values

Able to perform all essential duties with or without accommodations, including but not limited to:

Aggressive follow up in collecting from insurance companies
Skill in fast data entry and accuracy.
High level of discretional, interpersonal skills.
Tactfulness in dealing with patients, co-workers and other professional offices.
Knowledge of medical terminology
Interact with external/internal customers as necessary to resolve problems and expedite payments
Obtain status of outstanding claims
Problem Solving/Troubleshooting
Follow-up on outstanding AR balances assigned by supervisor or manager
Ensure timely and accurate processing of re-bills to the appropriate insurance companies
Provide detailed information regarding problem payors to management
Submit appeals based on denials from payor
Provide suggestions for solutions to management

Qualifications

Minimum of 2 year Medical Collections Experience
Minimum High School Diploma required
Knowledge of CPT, and/or ICD-10
Knowledge of legal and regulatory government provisions
Knowledge of laws that regulates communication and privacy act. HIPAA laws and understanding of the application

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