Reimbursement Specialist I

1w1 week ago

FFF Enterprises

Temecula, US · Full-time · $42,000 – $45,580

About this role

The Reimbursement Specialist I is a pivotal position requiring excellent communication skills, independent judgment, and ability to interact with private, state and federal payer representatives, fiscal intermediaries, case managers, pharmacy partners and NuFactor field personnel. This role coordinates reimbursement from product dispensing through to completion and final resolution of the payment cycle. Incumbent possesses basic knowledge of reimbursement principles and structure of various payer entities.

Daily tasks include submitting and following up on payer claims, verifying payment accuracy against fee schedules, and auditing accounts receivables for payments, discounts, adjustments, bad debt, recoupments and refunds. Draft professional cover letters, appeals, provider dispute forms, re-openings and reconsiderations as needed. Resolve credit balances via adjustments, transfers, recoupments or refunds.

Document all collection efforts accurately in the AR system and submit monthly claim status reports. Promptly inform management of reimbursement rates, changes or issues impacting receivables. Maintain records in compliance with company policies and procedures.

Attend departmental meetings, job-related trainings and educational seminars to improve processes and service quality. Support reimbursement activities for a $200 million annual revenue base with projected DSO under 40 days. Conduct special projects as requested by management.

Requirements

Excellent communication skills
Independent judgment
Basic knowledge of reimbursement principles
Knowledge of structure of private, federal and state payer entities and specific program issues
Ability to interact with payer representatives, fiscal intermediaries, case managers, pharmacy partners and field personnel
Understanding of accounts receivable auditing including payments, discounts, adjustments and recoupments
Proficiency in drafting appeals, cover letters and correspondence
Accuracy in documentation and reporting

Responsibilities

Submit and follow-up on payer claims including primary, secondary, tertiary claims and patient statements; verify accuracy of payments according to payer’s fee schedule
Audit accounts receivables analyzing payments, contractual discounts, adjustments, bad debt, recoupments, refunds and credit/debit functions
Draft professional, concise cover letters, appeals and correspondence including provider dispute forms, re-openings, reconsiderations
Resolve credit balances through revenue adjustments, balance transfers, recoupments and refunds
Document all collection efforts within the AR system and submit monthly claim status reports
Inform management of reimbursement rates, changes and issues affecting receivables
Maintain reimbursement records in compliance with company policies and procedures
Support reimbursement activities related to $200 million per year revenue base and projected DSO of less than 40 days