Medical Reimbursement Specialist

Location

Framingham, MA | United States

Job description

HealthDrive delivers on-site dentistry, optometry, podiatry, audiology, behavioral health, and primary care services to residents in long-term care, skilled nursing facilities. Each specialty offered by HealthDrive is one that directly impacts the quality of daily life for the deserving residents we serve. HealthDrive connects patients in need of vital healthcare to doctors committed to dignity and excellence . Our sunny corporate office is conveniently located off Route 9, close to routes 90 and 495 in a spacious modern office! Workout center available in the building! PPO Medical, Dental, and Vision plans available as well as a generous PTO policy.

We are seeking a full-time Medical Reimbursement Specialist in our corporate office in Framingham, MA. Responsible for daily follow-up on large volumes of unpaid/partially paid or denied claims for Optometry, Podiatry, Audiology, and some Dental services from insurance plans in 17+ states.

Primary duties are to review, resolve, and obtain payment on claims billed to Medicare Replacement, BCBS, Private Insurance and Medicaid / Medicaid Managed Care plans. The claims billed to insurances include but are not limited to: AARP, Aetna, Amerigroup, AmeriHealth, Anthem, Argus Vision, BCBS, Cigna, CCA, Communicare, Connecticare, Davis Vision, Envolve/Opticare, EyeMed, Fallon, Humana, KeyCare Advantage, March Vision, Medica, MEDEX, Molina, Optumcare/Anthem, Priority Health, Spectera, Superior Vision, Tricare, Tufts, UCARE, United Healthcare (UHC), WellCare, State Medicaid, and Medicaid Managed Care plans in 17+ states.

• Answer incoming facility and billing related customer telephone calls and provide exceptional customer service when interacting with business office managers, responsible parties, facilities, insurance plans and all internal and external customers
• Research and respond to all facility inquiries within 24 hours and document all interactions /actions taken in the patient record in the billing system
• Retrieve and respond to voicemail messages within 24 hours of message receipt date
• Complete refunds in billing system
• Obtain updated insurance information
• Make daily outgoing collection calls to facilities on outstanding balances
• Review patient accounts and all corresponding documents to accurately determine the patient’s or payer responsibility
• Identify and submit adjustment requests to the State for approval
• Assist with other duties, tasks and special projects as needed to help meet departmental objectives
• Attend meetings as necessary

The individual should have excellent communication skills both verbal and written with the ability to handle stressful situations with a calm demeanor while providing exceptional customer service. They should have the ability to work in a fast-paced, high volume environment and to work effectively and efficiently with both custom and “off the shelf” computer applications. Ability to navigate within Excel. The individual should be self-motivated with the ability to work well independently and as part of a team with minimal direct supervision. This individual should have a proven track record of dependability/reliability with an exemplary attendance record. They must be able to effectively multitask and possess excellent attention to detail with exceptional follow-up skills.

To qualify for this role the individual must have a HS diploma; Associate’s Degree (or equivalent) is preferred.

Preferred minimum of 2 years experience handling 3 rd party medical billing and collections calls. Knowledge and experience with medical terminology and reviewing medical insurance Explanation of Benefit (EOB) documents is preferred. Must be proficient in using Microsoft Applications (Word, Excel, Outlook, etc.) and have the ability to create and update Excel spreadsheets. 

Job tags

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