Reimbursement Analyst Full Time

Position Goal

Maintains overall understanding of insurance billing procedures to ensure appropriate follow up on claims adjudication and aging accounts receivable while maximizing timeliness and accuracy of reimbursement.

Position Responsibilities

  • Reviews claims in practice management system to ensure the payor specific billing requirements are adhered to as outlined.
  • Manages accounts receivable by performing required task to minimize claims worked volume in Payor hold/Manager hold buckets.
  • Follows up on claims processing, determines and applies appropriate adjustments, answers questions and updates accounts as necessary.
  • Utilizes payor portal(s) as the primary resource for claims processing.
  • Appropriately appeals insurance claims denials within a timely manner based on coverage/plan claims filing requirements.
  • Makes adjustments to claims required for proper claims submission as supported by documentation
  • Assists patients with questions/payments on accounts in a timely manner
  • Researches credit balances – resolve as appropriate to include meeting the weekly minimum requirement set forth by management.
  • Maintains collection goals outlined/communicated by/from management.
  • Maintains AR aging goals outlined/communicated by/from management.
  • Communicates areas of risk impacting any of the above items to management in a timely manner.
  • Attends and engages in training courses as scheduled by management.
  • Interacts with internal resources for claims resolution as applicable.

Experience: 2 years’ of provider medical collections experience preferred that demonstrates the following: insurance/claims processing, posting, modifier understanding/use, understanding of EOB’s, HCFAUB

Education: High school diploma or equivalent required.

Special Qualifications: Must be able to work independently. CPAR preferred.

Candidates who are hired are eligible to receive a Healthcare Financial Management Association (HFMA) membership and access to certification trainings.

The Hughston Clinic, The Hughston Foundation, The Hughston Surgical Center, Hughston Clinic Orthopaedics, Hughston Medical, Hughston Orthopaedics Trauma, Hughston Orthopaedics Southeast and Jack Hughston Memorial Hospital participate in E-Verify. This company is an equal opportunity employer that recruits and hires qualified candidates without regard to race, religion, color, sex, sexual orientation, gender identity, age, national origin, ancestry, citizenship, disability, or veteran status.


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