Reimbursement Resource Rep. (North Fort Myers)

The Reimbursement Resource Representative-AR is responsible for claim resolution and payment. The employee works insurance claims and patient accounts using department guidelines and MPG electronic systems. The position requires a thorough knowledge of insurance carrier billing and reimbursement, CPT, modifiers and fee schedule differences. Also requires understanding of how to decipher explanation of benefits and explain the impact to the customer. Position requires the ability to conduct both telephone and face to face meetings with patients regarding account resolution and payment collection. Expert verbal communication, interpersonal skills and professional appearance required for dealing with customers both internal and external. Additional duties as required.
Job Standards:
Effectively resolves unpaid, denied, appeals or overpaid claims while effectively utilizing carrier websites and automated inquiry systems to minimize phone/non-productive time
Supports the Customer Service Team as needed
Meet timelines for Athena claims follow up
Demonstrate interpersonal skills with patients, co-workers and insurance carriers
Advanced knowledge of cpt and modifiers
Correspondence & voicemails returned within same day 1 business day
Claim adjudication carrier rules knowledge are current and meets/exceeds monthly performance goals, expectations and reviews.
Monitors denials for potential trends and effectively communicates these issue with management.
Uses Paid Time Off effectively
Keeps overtime to a minimum/has any overtime approved by Manager
Actively participates in team meetings and educational opportunities.
Conducts themselves in accordance with MPG Policies and Procedures including the Code of Conduct.

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