Reimbursement Consultant (Bilingual - Spanish)

Reimbursement Consultant (Bilingual - Spanish)

Title: Reimbursement Consultant (Bilingual - Spanish)
Location: United States-California-San Mateo
Job Number:_0000111M
Under the general supervision of the Reimbursement Supervisor, is responsible for various reimbursement functions including but not limited to accurate and timely claim submission claim status collection activity appeals payment posting and/or refunds until accounts receivable issues are properly resolved.
* Collects and reviews all patient insurance information needed to complete the billing collections appeal and/or cash processes.
* Completes and submits all necessary insurance forms and electronic claims to process the claims in a timely manner as required by all third party payors. Researches and resolves any electronic claim denials.
* Effectively utilizes various means for collections including but not limited to phone fax mail and online methods.
* Provides exceptional customer service to internal and external customers; resolves any customer requests in a timely and accurate manner; escalates complaints accordingly.
* Maintains frequent phone contact with provider representatives third party customer service representatives pharmacy staff and case managers.
* Independently analyzes reports resolves and communicates any reimbursement trends/delays (e.g. billing denials claim denials pricing errors payments etc.).
* Processes any necessary insurance/patient correspondence.
* Provides all necessary documentation required to expedite payments. This includes demographic authorization/referrals National Provider Identification (NPI) number and referring physicians.
* Coordinates with inter-departmental associates to obtain appropriate medical records as they relate to the reimbursement process.
* Provides training and support to inter-departmental associates.
* Verifies transactions and processes comply with organizational and departmental policies and procedures; suggests changes and solutions as appropriate.
* Independently and effectively resolves complex accounts with minimal supervision.
* Demonstrates an understanding of complicated reimbursement issues including but not limited to pricing contract analysis payor requirements and operating systems.
* Maintains confidentiality in regards to patient account status and the financial affairs of clinic/corporation. Communicates effectively to payors and/or claims clearinghouse to ensure accurate and timely electronically filed claims.
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May be responsible for coordination of services with field reimbursement teams and sales representatives. Demonstrates an understanding of complicated reimbursement issues.
a. Job Complexity: Works on complex issues where analysis of situations or data requires in-depth evaluation of variable factors. Exercises judgment in selecting methods techniques and evaluation criteria for obtaining results. Networks with key contacts outside own area of expertise.
b. Supervision: Acts independently to determine methods and procedures on new or special assignments. May be responsible for coordination of services with field reimbursement teams and sales reps.
* Performs related duties and special projects as assigned.
Requires broad training in fields such as business administration, accounting, computer sciences, medical billing and coding or similar vocations generally obtained through completion of a two year associate's degree program technical vocational training or equivalent combination of experience and education. Five (5) or more years directly related and progressively responsible experience preferred.
* Ability to communicate effectively both orally and in writing in both English and Spanish.
* Strong interpersonal skills.
* Strong negotiating skills.
* Strong mathematical skills.
* Strong analytical skills.
* Strong organizational skills; attention to detail.
* Extensive knowledge of accounting principles pharmacy operations and medical claims.
* Extensive knowledge of HCPCS CPT ICD-9 and ICD-10 coding.
* Comprehensive understanding of commercial and government payers.
* Ability to expertly use Microsoft Excel Outlook and Word.
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Having wide-ranging experience uses professional concepts and company objectives to resolve complex issues in creative and effective ways.
Job: Customer Service & Call Center