Payment Reconciliation Specialist

Location

North Richland Hills, TX | United States

Job description

Payment Recovery Specialist
Salary - Full Time
About R3
R3 Wound Care & Hyperbarics (R3) is an innovative, alternative, and patient-centric provider of healthcare services across the Dallas Fort Worth (DFW) metroplex, Houston, and San Antonio. We are entering an exciting phase as a company, with a strategic focus on enhancing the current clinical delivery model and platform, and then leveraging that platform to grow the business and the footprint of our clinics.  Our culture at R3 is predicated on each one of our employees willingness to pitch in, wherever necessary, to ensure our patients are served at the highest quality levels of care and comfort.
R3 Benefits:
Our team members receive personal satisfaction knowing that they are helping people heal. Additionally, they receive a very competitive base compensation and attainable monthly incentive pay. Eligible team members also receive a comprehensive benefits package including PTO, Holiday, Bereavement, and Maternity Leaves; 401k; company sponsored health and dental insurances; a full array of voluntary benefits; continuous clinical training; and professional development, led by the R3 Chief Medical Officer.
Summary of Role & Qualifications
The focus of this job is on producing high quality, detailed work based on established standards, guidelines and procedures related to billing, collections, and the overall revenue cycle department. Precise, consistent work output is essential requiring patience and a willingness to handle and complete one task at a time.  Job knowledge and competency is built through structured step-by-step training and positive, supportive coaching from management and peers. Knowledge of third-party commercial and governmental payers, and their relationships with providers and their patients, is critical in being successful in this role.  Communication with others is based on knowledge of repetitive job routines and procedures gained from sufficient on the job experience. Consistent, error free work based on defined regulations and standards are key measures of job performance success. The job environment promotes steady, methodical work output so that job routines can be completed on time and error-free. This position is designed to develop a valued technical expert, who, recognized and supported by management and a stable work environment, can deliver quality work on a consistent basis.

• Outbound calls to payors regarding claims status.
• Outbound calls to patients regarding patient inquiries for account status
• Experience with Health Fusion or Wound Expert systems
• Review medical records and accounts as needed
• Accurately document all calls made or received
• Responsible for scanning, faxing, and emailing documents as needed
• Communicate with coworkers as needed regarding claims/denials updates and concerns
• Understand and follow proper medical claims collection Company Standard Operating Procedures
• Comply with all patient privacy and HIPAA rules
• Ensure proper reimbursement of paid claims 
• Prepare reconsideration or appeal letters to payors when required
• Understand managed care authorizations and limits to coverage such as the number of visits or medical policy and patients benefit plan
• Be able to read and understand patient insurance verifications, payor policies, signed agreements on file, payor EOBs and correspondence
• Ability to look up and understand ICD10 diagnosis, and CPT treatment codes from online sources or traditional coding references 
• Knowledgeable about the insurance and reimbursement process

• Must have a professional and positive demeanor
• Medical coding certification is preferred
• Must have 3 years of medical collections experience required
• Self-starter who works well independently and as a member of a team.
• Must be proficient in organization and multitasking
• Must be proficient with Outlook, Word, Excel, Payor portals, and referencing payor policies

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