Reimbursement Specialist is responsible for reviewing insurance claims in the billing department. The job description entails the clients receive accurate reimbursements for the claims. A well-drafted Reimbursement Specialist Resume indicates the following duties and tasks – providing administrative aid to medical professionals; helping patients in processing insurance reimbursements, and making billing payments; managing financial and medical records; transcribing medical reports, greeting new patients and scheduling appointments. The job duties also include determining the method of payment for patients, investigating claims issues and making necessary recommendations to the management.
Candidates with the following skills can stand out while a chief search for this vacancy is made – a good understanding and familiarity with medical office administration and medical terminologies; solid written and verbal communication skills, knowledge of accounts receivables and insurance collections; and well-versed with company’s rules and regulations. Though a college education is not necessarily required, industry-specific knowledge and experience are required.
Summary : Dynamic Reimbursement Specialist with a decade of expertise in claims processing and insurance verification. Proven track record in optimizing reimbursement processes and enhancing patient access to necessary therapies. Committed to ensuring compliance with regulatory standards while delivering exceptional service to clients and healthcare providers.
Skills : Claims Processing, Medical Coding, Insurance Verification, Patient Billing
Description :
Conduct comprehensive benefit investigations and verify insurance coverage for patients, ensuring accurate processing of claims.
Manage prior authorization requests, successfully obtaining necessary approvals to facilitate patient access to treatments.
Maintain meticulous records in the client database, ensuring data integrity and compliance with regulatory standards.
Collaborate with healthcare providers and insurance representatives to resolve billing discrepancies and expedite claim processing.
Participate in strategic discussions with client management to enhance reimbursement strategies and service delivery.
Serve as a primary point of contact for patients, guiding them through the reimbursement process and addressing concerns promptly.
Monitor and report on outstanding claims, implementing follow-up procedures to ensure timely resolutions.
Experience
7-10 Years
Level
Management
Education
B.S. Health Admin
Sr. Reimbursement Specialist Resume
Summary : Accomplished Reimbursement Specialist with 10 years of comprehensive experience in claims management and patient advocacy. Expertise in optimizing reimbursement workflows and ensuring compliance with healthcare regulations. Passionate about enhancing operational efficiencies and improving patient access to critical services.
Skills : Attention to Detail, Client Relations, Microsoft Word, Microsoft Excel, Data Entry
Description :
Verify insurance coverage, negotiate reimbursement rates, and secure necessary authorizations for services.
Monitor accounts for timely payments and escalate issues regarding payer discrepancies to management.
Maintain accurate patient records in compliance with legal and regulatory standards, ensuring confidentiality and adherence to HIPAA.
Oversee billing data for up to 400 patients and payroll for 18 clinical staff using CaseMatch software, ensuring accuracy and timeliness.
Review and validate information in databases to ensure compliance with federal healthcare regulations and company policies.
Assist in the preparation of compliance documentation for internal audits and external regulatory reviews.
Experience
10+ Years
Level
Senior
Education
B.S. Health Admin.
Jr. Reimbursement Specialist Resume
Objective : Experienced Reimbursement Specialist with 5 years of expertise in claims processing and patient support. Adept at maximizing reimbursement efficiencies and ensuring compliance with industry regulations. Passionate about improving patient access to healthcare services while providing exceptional support to healthcare teams and clients.
Skills : Attention to Detail, Data Entry, Healthcare Coding Knowledge, Advanced MS Office Suite, Email Management
Description :
Accurately processed and posted all cash, checks, credit cards, and electronic payments to patient accounts.
Conducted thorough research to resolve reconciling items, collaborating with internal teams to correct discrepancies.
Created and posted adjusting entries to clear outstanding reconciliations efficiently.
Audited and processed patient refunds, ensuring timely identification of overpayments based on established policies.
Led the transition from paper batch posting to digital CashPro imaging, enhancing processing speed.
Played a key role in integrating GE Groupcast practice management, ensuring proper electronic remittance acceptance.
Managed banking reports and monthly reconciliations, providing accurate financial data to stakeholders.
Experience
2-5 Years
Level
Junior
Education
B.S. Health Admin.
Jr. Reimbursement Specialist Resume
Objective : With five years of dedicated experience as a Reimbursement Specialist, I excel in claims processing and insurance verification. I have a strong ability to streamline reimbursement workflows, ensuring compliance with healthcare regulations while enhancing patient access to vital services. My commitment to operational excellence drives successful outcomes for both clients and healthcare providers.
Utilized provider guidance and eligibility processes to update internal systems for enrollment into Express Scripts Prescription Drug Plan.
Served as the primary contact for internal clients and members during the enrollment process.
Managed outbound and inbound communications with physician offices, patients, and potential clients regarding member eligibility.
Exercised independent judgment to resolve complex or critical issues efficiently.
Collaborated with eligibility analysts and account managers to ensure seamless client support.
Identified and escalated recurring issues for prompt corrective action.
Maintained thorough documentation of all interactions to enhance process integrity and mitigate legal risks.
Experience
2-5 Years
Level
Junior
Education
B.S. in HA
Lead Reimbursement Specialist Resume
Headline : Experienced Reimbursement Specialist with expertise in Medicare and Medicaid regulations. Achieved a 95% accuracy rate in claims submissions, significantly enhancing revenue cycle efficiency and reducing payment delays.
Skills : Microsoft Excel, Communication Skills, Time Management, Team Collaboration, Healthcare Regulations
Description :
Support practice management by managing patient records and ensuring accurate billing information.
Gather and verify insurance details for diagnoses and procedures rendered to patients, providing essential information to healthcare providers.
Leverage extensive knowledge in billing and reimbursement to accurately document medical records.
Foster collaborative relationships with departments, payers, and business partners to advocate for the interests of patients and the practice.
Minimize rejected claims by meticulously reviewing medical documentation to confirm insurance coverage for treatments.
Conduct outbound calls to insurance companies to verify patient benefits and eligibility.
Proactively address compliance-related matters by ensuring CPT and ICD coding accuracy according to regulatory standards.
Experience
5-7 Years
Level
Executive
Education
B.S. Health Admin.
Reimbursement Specialist III Resume
Summary : Detail-oriented Reimbursement Specialist with over 5 years of experience in claims processing and denial management. Proven track record of increasing reimbursement rates by 20% through effective follow-up and negotiation strategies.
Managed accounts receivable for a Joint Commission accredited medical equipment provider, enhancing cash flow and reducing outstanding balances.
Directed all facets of billing and collections, ensuring compliance with insurance regulations and timely payment processing.
Reviewed claims pre-billing for accuracy and completeness, achieving a 98% first-pass resolution rate.
Gathered and validated necessary documentation for claims submissions, reducing denial rates.
Specialized in Medicare billing, maintaining over an 80% success rate in appeals at the ALJ level.
Ensured compliance with Medicare Supplier Standards, enhancing operational integrity.
Maintained and updated insurance contracts and fee schedules, optimizing reimbursement rates.
Experience
10+ Years
Level
Senior
Education
B.S. in HA
Reimbursement Specialist II Resume
Headline : Dedicated Reimbursement Specialist with a focus on optimizing reimbursement processes. Successfully managed a portfolio of accounts, resulting in a 15% increase in collections and improved cash flow for the organization.
Skills : CMS-1500 Claims Processing, Allscripts EHR Proficiency, Email Communication Management, Document Preparation and Management, Healthcare Administration Procedures
Description :
Collects and reviews patient insurance benefits information according to program SOPs.
Assists physician office staff and patients in completing and submitting insurance forms and applications.
Submits necessary insurance forms and electronic claims to ensure timely processing by third-party payers.
Researches and resolves electronic claim denials effectively.
Investigates and addresses claim denials or underpayments to ensure accurate reimbursements.
Utilizes multiple collection methods, including phone, fax, mail, and online channels.
Delivers exceptional customer service to internal and external clients, resolving inquiries promptly and escalating issues as necessary.
Experience
5-7 Years
Level
Executive
Education
BSHA
Reimbursement Specialist I Resume
Objective : Proficient Reimbursement Specialist with five years of focused experience in claims processing and revenue cycle management. Skilled in enhancing reimbursement accuracy and compliance while facilitating patient access to healthcare services. Committed to optimizing operational workflows and providing exceptional support to healthcare teams and patients.
Identified and explored additional revenue opportunities for hospital-based physician earnings.
Analyzed financial transactions and provided variance analysis identifying trends and solutions affecting revenue.
Maximized cash collections through efficient processes, revenue identification, and timely collection of receivables.
Monitored insurance carrier reimbursement trends to inform forecasting strategies.
Tracked and analyzed key financial metrics for optimal revenue results.
Created and maintained financial databases for senior management and physician review.
Followed up on outstanding accounts, reviewed medical claims for accuracy, and managed aging reports, resulting in an additional $1.9 million in recoveries.
Experience
2-5 Years
Level
Executive
Education
B.S. in HA
Reimbursement Specialist/Analyst Resume
Summary : Seasoned Reimbursement Specialist with 10 years of experience in claims processing and insurance reimbursement strategies. Skilled in navigating complex regulatory environments and streamlining workflows to boost efficiency. Dedicated to enhancing patient access to healthcare services while ensuring compliance and delivering high-quality support to healthcare providers.
Skills : Microsoft Office Suite, Email Communication Management, Analytical Skills, Conflict Resolution, Quality Assurance
Description :
Evaluated and processed claims for the Bayer Pharmaceutical Diabetes patient assistance program, ensuring eligibility and compliance.
Managed inbound inquiries from healthcare professionals and patients regarding insurance and reimbursement issues.
Documented payer and billing information accurately in operational systems to maintain up-to-date records.
Served as a liaison between providers and sales representatives to resolve prior authorization inquiries and appeals efficiently.
Conducted comprehensive research on payer policies to ascertain coverage benefits for patients.
Maintained and updated databases reflecting changes in payer policies to ensure compliance.
Prepared detailed reports for management, summarizing reimbursement trends and patient access outcomes.
Experience
7-10 Years
Level
Management
Education
B.S. Health Admin.
Reimbursement Specialist/Executive Resume
Objective : Results-oriented Reimbursement Specialist with 5 years of extensive experience in claims processing and revenue cycle management. Skilled in enhancing reimbursement accuracy and navigating complex regulatory environments. Adept at fostering strong relationships with clients and healthcare providers to optimize service delivery and ensure compliance.
Skills : Effective Time Management, Multi-tasking, Organizational Skills
Description :
Managed claims processing and follow-up for corporate clients, ensuring timely reimbursement.
Analyzed unpaid accounts to determine status and initiated appropriate actions for payment recovery.
Collaborated with corporate clients to resolve reimbursement issues, enhancing client relationships.
Established effective communication with account managers and accounts payable departments to streamline billing processes.
Reviewed contracts and policies to ensure compliance and accuracy in billing cycles.
Conducted thorough research on payment discrepancies to facilitate cash applications across multiple accounts.
Oversaw accounts exceeding $1 million in weekly revenue, ensuring optimal financial management.
Experience
2-5 Years
Level
Executive
Education
B.S. Health Admin.
Associate Reimbursement Specialist Resume
Objective : Dynamic Reimbursement Specialist with a proven ability to navigate complex healthcare billing systems. Recognized for reducing outstanding claims by 35% through diligent follow-up and effective communication with insurance providers.
Skills : Excel Proficiency, PowerPoint Presentation Skills, Web Research Skills, Email Communication, Word Processing Skills
Description :
Reviewed and processed patient information for collections and insurance claims.
Communicated effectively with patients, providers, and insurance companies to resolve billing inquiries.
Accurately recorded daily cash and credit transactions, ensuring all vouchers and EOBs were posted.
Managed monthly payment reconciliations and coordinated with collection agencies.
Examined insurance claims to guarantee accurate reimbursements for patients.
Maintained strong attention to detail while adhering to office processes and procedures.
Ensured timely payments according to insurance contracts and agreements.
Experience
2-5 Years
Level
Junior
Education
B.S. in Health Admin.
Reimbursement Specialist Resume
Summary : Proficient Reimbursement Specialist with 10 years dedicated to optimizing claims processing and enhancing patient access to healthcare services. Demonstrated success in navigating complex reimbursement protocols while ensuring compliance with regulatory standards. Passionate about driving operational improvements and fostering strong partnerships with healthcare providers.
Skills : Bilingual in Spanish and English, Microsoft Office Suite, Adobe Creative Suite, Adobe Photoshop, Adobe Lightroom
Description :
Managed communication with healthcare professionals, patients, and sales representatives regarding reimbursement inquiries.
Provided expert assistance in medical and pharmaceutical reimbursement requests, ensuring timely resolution.
Delivered accurate billing and coding information for specific products, including CPT and ICD-10 codes.
Verified patient insurance benefits and conducted thorough payer research to optimize claims submissions.
Collaborated with insurance payers and healthcare professionals to resolve prior authorization issues and appeals.
Developed reimbursement tools and program SOPs in alignment with program manager requirements.
Prepared comprehensive reports using MS Word, PowerPoint, and Excel to support program management efforts.
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