Reimbursement Specialist Resume Samples

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Reimbursement Specialists collaborate with health care professionals and process insurance reimbursements. They make sure that customers receive accurate reimbursement for their claims, update patient files, investigate claim issues and even make recommendations to the health care unit's management. Employers prefer candidates who are able to display in their resumes medical terminology knowledge, attention to details, insurance billing expertise, independent thinking, computer competencies and good communication skills. A certificate in medical billing or a similar field is common experience in Reimbursement Specialist resume examples.

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1

Reimbursement Specialist

Coordinated billing, customer collections, cash application and pricing departments to secure payment on 1,000 patient accounts

  • Analyzed and reviewed accounts receivable aging to report to senior management
  • Tailored unique collections processes according to departmental guidelines
  • Responsible for $3.5 million in accounts receivable on government payors
  • Maintained bad debts at less than 2% sales
  • Collected assets by ensuring timely and accurate follow-up for assigned therapies
Candidate Info
12
years in
workforce
2
years
at this job
BS
Business Management
2

Reimbursement Specialist

Initially responsible for providing accounting support to five branch offices, each containing approximately 60 accounts and totaling $1.2M in accounts receivable

  • Progressed to being responsible for larger more complex offices totaling $2.2M in accounts receivable while maintaining 9% over 90 surpassing department standards
  • Became responsible for supporting high profile National Accounts team and Maxim Health Information Systems, combined total accounts receivable of $7M
  • Served as lead accounting contact by collecting, analyzing and prioritizing delinquent accounts' information to provide direction and support to National Directors and Account Executives
  • Recognized by manager and peers as subject matter expert and selected to train all new hires
  • Selected by managers as corporate liaison for one of our most difficult National Accounts; analyze invoices for all teams and direct all collection efforts
  • Analyzed financial credit reports and perform background investigations on potential clients
Candidate Info
10
years in
workforce
3
years
at this job
BS
Financial Economics
3

Reimbursement Specialist

Responsible for A/R for 20 physicians to insure timely and full allowable amount of payment according to BCBS, Aetna and Medicare contracts.

  • Adjudication of appeals for various coverage issues and medical necessity denials for high dollar claims.
  • Interpret medical records to insure coverage based on established medical policies for various chemotherapy and radiation treatments.
  • Created, reviewed and analyzed reports which allowed identification of coding errors and payer trends.
  • Daily transmission of electronic claims and follow-up of rejected claims including correction of ICD9, HCPCS, modifier, or other claim reject issues.
Candidate Info
14
years in
workforce
3
years
at this job
Adn
4

Inside Sales/reimbursement Specialist

Coordinated sales transactions and collected payables on orders initiated by outside sales representatives.

  • Filed insurance claims to Medicare and other private insurance companies.
  • Provided support to outside sales force by assisting with reimbursement training.
  • Addressed and answered insurance-related questions from sales representatives and customers.
  • Assessed and reconciled past due accounts in time-efficient manner.
  • Answered customer inquiries and resolved issues regarding insurance coverage, billing, and claim status.
Candidate Info
7
years in
workforce
4
years
at this job
BS
Education
5

Reimbursement Specialist

Performed reimbursement functions with focus on collections. Responsible for resolving returned, disputed or rejected claims from payors.

  • Worked on aged receivables and identified improper payments, inappropriate claim denials, billing errors and discrepancies on all returned claims through final resolution.
  • Contacted insurance companies and third parties payors regarding errors and discrepancies.
  • Resolved errors by resubmitting corrected or unacknowledged claims, medical records, appeals and other documentation required for timely payments.
  • Issued refunds as needed.
  • Educated in Medical Terminology, EOB's, Remittances, CPT and ICD9.
  • Worked independently and as a team member.
  • Assisted with cash application and billing at months and year ends when needed.
  • Discovered and led a project to recover funds paid to patients once it was determined insurance companies were issuing payment to the members in an early stage company. Received the Pacemaker Award in recognition for recovering $77k that was considered uncollectable.
Candidate Info
6
years in
workforce
1
year
at this job
BA
Sociology
MA
Medical Coding And Billing
6

Billing Operations / Reimbursement Specialist

Created, analyzed and processed Accounts Receivable reports for Commercial, Traditional / Managed Care Medicare and Medicaid.

  • Identified trends of payment / non-payment from insurance carriers. Developed relationships and worked in cooperation with carrier contacts to resolve issues and secure monetary settlements.
  • Developed and maintained appeals process for denied claims.
  • Trained and mentored new employees on all processes relating to their positions.
  • Served as active member of NTD Labs Site Committee, which organized corporate social responsibility and employee oriented functions.
  • Honored by management for Job Excellence.
Candidate Info
10
years in
workforce
2
years
at this job
HS
Regents
7

Reimbursement Specialist

  • Billed and collected for insurance/Medicaid claims submitted on behalf of two Maxim branch offices with sales totaling $750-$800K per month
  • Managed an aging accounts portfolio to satisfy delinquent accounts
  • Ensured strict compliance and adherence to State and Federal laws and regulations regarding medical reporting
  • Collected over $1 million in aging accounts in less than one year
  • Conferred with management to reduce operating costs and maximize profit
  • Helped to develop a new Medicaid billing system to increase efficiency and accuracy
Candidate Info
9
years in
workforce
3
years
at this job
BS
Business Management
8

Reimbursement Specialist / Poster

Processed correspondence received EFT's, lock boxes, credit cards, and check payments, daily deposits.

  • Investigated and resolved issues with Medicare, Medicaid, Medcost, Veterans Administration, Tricare, PHCS and other commercial insurance carriers.
  • Audited electronic claim filing process to ensure timely payment for Professional and Institutional claims.
  • Assisted patients in understanding their charges and responsibilities, set payment plans, collections, and A/R productivity
  • Assisted in web-based program Allscripts to monitor claims for rejections, insurance eligibility, and remittance notices for electronic payment.
Candidate Info
9
years in
workforce
4
years
at this job
9

Medical Biller/reimbursement Specialist

Performed all front office responsibilities including assisting with reception, performing full cycle billing and collections.

  • Check patients in and out, collected co-payments, explained patient responsibility, processed referrals, scheduled patients, and completed patient registration.
  • Touch an average of 75 claims a day for both billing and collections purposes.
  • Responsible for accounts receivable duties, submitting electronic claims, verifying eligibility and benefits, and insurance follow-up.
  • Performed the appeals and denial process; re-billed and researched discrepancies.
Candidate Info
8
years in
workforce
1
year
at this job
Medical Administrative Assistant
Medical Billing And Coding Specialist
10

Reimbursement Specialist

Edited and billed home infusion pharmacy and DME claims for various State Medicaid's and government payers

  • Proficient in processing drug and pharmacy benefit claims though DayTech Claims Engine 2000
  • Collaborated with collections division to research claims submission errors or payer requests to quickly and accurately collect payment for pharmacy shipments
  • Researched and abided by all company and payer reimbursement policies, procedures, and guidelines to maintain compliance
  • Collaborated with management to suggest submission corrections to reduce payment delays based on denial research efforts
  • Consistently met and exceeded all productivity outlines
Candidate Info
15
years in
workforce
6
years
at this job
HS
Computer Programming
BA
Laboratory Technology

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