Reimbursement Specialist (Home Health & Hospice Collections Exp)

• Accurately interprets patient insurance, prescription and other health-related documentation
• Conducts medical insurance verifications and investigations for commercial and government payors
• Communicates with insurance companies, patients, providers and prescribers to coordinate reimbursement and access solution
• Reviews unpaid accounts to determine status and taking appropriate action to ensure payment.
• Reviews all claims for compliance and completeness for claims submissions.
• Researches available alternative funding options to reduce patient’s financial burden
• Handles high call volumes
• Communicates with internal and external departments to facilitate coordination of care
• Maintains a high degree of confidentiality at all times due to access to sensitive information
• Maintains regular, predictable, consistent attendance and is flexible to meet the needs of the department
• Follows all Medicare, Medicaid, and HIPAA regulations and requirements
• Abides by all regulations, policies, procedures and standards
• Performs other duties as assigned

• High school diploma or equivalent is required; Undergraduate degree is preferred
• 5 years of healthcare collections/billing experience preferred
• Strong understanding of hospice billing regulations (Medicare, Medicaid, commercial
• Ability to read and interpret EOBs, remittances, and denial codes
• Effective payer follow-up and escalation strategies
• Ability to resolve claim holds, rejections, and denial
• Ability to identify trends in denials or delay
• Root-cause analysis to prevent recurring issues
• High attention to detail to ensure clean claims
• Ability to work AR reports and aging summaries accurately
• Clear, professional communication with internal teams and payer reps
• Ability to explain payer issues in plain, understandable language
• Possess quick and accurate Alpha/numeric data entry skills
• Computer proficiency – MS Office and Web-enabled applications strongly preferred
• Customer service skills required.
• Maintains positive internal and external customer service relationships
• Plans and organizes work effectively and ensures its completion
• Meets all productivity requirements
• Demonstrates team behavior and promotes a team-oriented environment
• Actively participates in Continuous Quality Improvement
• Represents the organization professionally at all times
• Self-starter with exceptional organizational and follow-through skills
• Ability to work independently and in a team environment

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