Insurance Reimbursement Specialist

Job Description

Job Description

At Aylo Health, we work together to enrich the health and well-being of every life we touch. Our mission is to make quality healthcare simple and convenient. Because healthy people can do amazing things!

We offer a work environment that values the creation of lifelong relationships, while also providing opportunities for growth and career development. We strive to care for each other with the same passion with which we care for our patients. Aylo Health offers competitive pay to team members who provide high-quality care, while delivering an exceptional patient experience.

JOB SUMMARY:

The Insurance Reimbursement Specialist will be responsible for document retrieval, analysis, claim processing, and reimbursement.

ESSENTIAL FUNCTIONS:

• Have a full understanding of a medical claim cycle
• Possess the necessary knowledge to identify claim issues and apply resolutions to them
• Have a full understanding of the remit advice. Understand CAS codes and remark codes
• Understand and able to submit corrected claims, appeals, reconsiderations, medical necessity letters, etc.
• ICD diagnosis coding, modifier application and verification of CPT and/or HCPCS codes
• Responsible for ensuring all claims processed through EMR are correct and compliant
• Responsible for performing AR follow up
• Keeps abreast of and complies with coding guidelines and reimbursement reporting requirements.
• Daily review and follow up on all incomplete electronic provider-billing encounters.
• Ability to identify issues, correct code and/or pend due to missing information.
• Apply in depth knowledge of coding principles to validate missing or incomplete CPT, HCPCS, or ICD-10 codes.
• Appropriate assignment of diagnosis codes to CPT codes.
• Review and completion of claim edits
• Review of Denials including writing appeals and facilitating their submission.
• Have vast knowledge of medical insurance rules and proper filing guidelines
• Ability to maximize reimbursement for claims.
• Ability to run standard reconciliation reports.
• Answer patient calls/questions, clinic staff calls, and insurance company calls
• Ensure resubmission of claims, when applicable, are accurate
• Ensure reimbursement of claims by submitting the most appropriate coding for services performed
• Maintain a professional relationship with insurance companies and patients
• Other duties as assigned

QUALIFICATIONS REQUIRED:

• A minimum of 3 - 5 years of medical ICD & CPT coding experience, Family Practice or Clinic setting is preferred
• Electronic Medical Record experience, eCW software highly preferred
• Excellent communication skills
• Problem solving skills
• Computer literate with entry level working knowledge of Microsoft Suites; Outlook, Word, Excel
• Demonstrated ability to organize, coordinate, prioritize, and facilitate many on-going tasks at one time
• Duties require professional verbal and written communication skills
• Ability to work independently or with a team
• Professional appearance
• Positive attitude

MINIMUM REQUIRED EDUCATION/TRAINING:

• High School graduate or equivalent required
• Preferred but not required: AHIMA or CPC

Aylo Health is an Equal Opportunity Employer

Aylo Health is an Equal Opportunity Employer