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Reimbursement Specialist Job Description

The following is a sample job description for a Reimbursement Specialist to reference when building your resume. Assess the qualifications and requirements listed to get an understanding of what you need to include on your resume for what employers expect in this field.

SUMMARY:

Reimbursement specialists are responsible for ensuring that clients are reimbursed for all services rendered. They also ensure that the company’s policies and procedures are followed, and they are responsible for conducting investigations into suspicious claims.

This position will be accountable for efficient and accurate processing of claims that are submitted by physicians and other providers. The Reimbursement Specialist will also conduct research on claims to ensure that all applicable insurance coverage has been applied and/or denied in accordance with company policies. The Reimbursement Specialist must adhere to all HIPAA regulations and maintain confidentiality at all times.

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FUNCTIONAL DUTIES:

  • Research and process insurance claims from patients, physicians and third-party payers.
  • Review claims for accuracy and ensure compliance with company policies and procedures.
  • Maintain current knowledge of all relevant insurance regulations, rules, guidelines and procedures.
  • Ensure medical records are maintained in accordance with HIPAA regulations, as well as other state and federal laws or regulations governing protected health information (PHI).
  • Assist in identifying opportunities for cost savings or revenue enhancement through various processes including utilization review; claims processing; auditing; coding; etc., while also maintaining compliance with all applicable laws and regulations governing protected health information (PHI).

REQUIREMENTS:

  • Bachelor’s degree in a relevant field (i.e., accounting, finance).
  • 2-5 years’ experience working in reimbursement or claims processing.
  • Proficiency with Excel and Google Sheets for data entry and analysis.
  • Ability to work independently with minimal supervision, as well as collaboratively in a team environment.
  • Familiarity with the HIPAA Privacy and Security Rules and state privacy laws preferred.
  • Excellent communication skills both written and verbal.
  • Strong organizational skills and attention to detail.

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