Our Frisco, TX client is looking for an Reimbursement Specialist on a contract to possible hire basis.
Responsibilities:
Benefit verification for patient information submitted
Creation of estimates of expected reimbursement for patient information submitted
Guide providers through the process-request all needed documentation to determine medical necessity and ensure best processing outcome for each claim
Communicate with providers regarding the status of their patients’ health claims
Review health records and documentation submitted to ensure the patient meets medical necessity criteria for coverage
Submission of pre-authorization requests to payers/request in-network exception for out of network claims
Submission of health claims to payers
Claims follow up – management of reconsiderations and appeals of denied claims
In network provider pre-authorization submission & DME benefits verification
Contacting in-network patients to alert of authorization, discuss DME benefits, and direct to authorized client company dentists for therapy
Participating Plan Relations – managing member authorizations, submissions, claims, reporting
Collection of patient cost share (co-pay, co-insurance) and coordinate case release with logistics department
Qualifications:
Minimum 2 years of experience in insurance/medical office– electronic claims submission and pre-authorization experience preferred
Strong Medicare claims/billing knowledge required
BS/BA degree-preferred, not required
High level knowledge-medical coding/ billing
High level knowledge-health claims submission process
Proficiency with Microsoft Office suite
Strong verbal/written communication skills
Attention to detail, ability to maintain follow up with all stakeholders
Ability to manage and prioritize multiple projects and tasks
Please visit us on the web at http://www.frontlinesourcegroup.com
Equal Opportunity Employer, M/F/V/D. Candidates must have authorization to work in the U.S. Clients will not sponsor visas.
Frontline Source Group™ is one of the fastest growing Information Technology, Accounting, Legal, Human Resources, Administrative, and Clerical staffing and direct hire firms with offices throughout Texas (Arlington, Austin, Dallas, Fort Worth, Plano, Houston Galleria, Lewisville, West Houston, San Antonio, Sugar Land, and The Woodlands), Tennessee (Nashville and Brentwood), and Arizona (Phoenix and Scottsdale).
Frontline specializes in matching top talent with companies for direct, contract, and contract-to-hire placements. We work with clients and candidates in all areas of the United States and Canada.