Medical Reimbursement Specialist

Houston, TX

Posted: 11/06/2018 Employment Type: Contractor Industry: Health Care, Admin - Clerical Job Number: JD816Y6WPHD53XCQZJ3

Pulse Staffing has a contract assignment available for an experienced insurance reimbursement specialist. This opportunity is working from home, with one of our busy, growing clients. You must be in the Houston area to be considered.

Duties include:

*Providing effective collaboration as the liaison between the reimbursement team, surgeon's office, and patient to coordinate attempts to secure coverage for procedure.

*Provide high quality customer service.

*Communicate with patient's insurance coverage to determine process for pre-auth/pre-determination through all levels of appeals, manage the insurance authorization process, including insurance verification, prior-authorization, and the appeal process.

*Coordinate securing patient's supporting medical documentation, letters of medical necessity, and appeal letter signatures from referring surgeons.

*Guide patient through the insurance coverage support process, while addressing patient concerns.

*Track, monitor, and report the outcomes of reimbursement initiatives - appeal outcomes from peer to peer review, external medical review, etc.

*Maintain complete and accurate documentation of all inquiries.

*Other duties as assigned.

*High School diploma or GED

*Associates in medical billing, coding, or health information management preferred

*Five+ years of recent experience with health insurances, benefit investigation, and reimbursement, along with billing and coding

*Experience with prior authorizations and reimbursement

*Experience with medical appeals

*Excellent written and verbal communication skills

*Effective problem solving skills.

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