Reimbursement Representative

USRC's greatest strength in being a leader in the dialysis industry is our ability to recognize and celebrate the differences in our diverse workforce.

We strongly believe in recruiting top talent and creating a diverse and inclusive work climate and culture at all levels of our organization.

SUMMARY

The Reimbursement Representative performs reconciliation and review of all outstanding Medicare/Commercial patient balances in accordance with US Renal Care reimbursement policies and procedures.

Essential Duties and Responsibilities include the following.

Other duties and tasks may be assigned.


* Reviews EOB/EOMB's for proper reimbursement.


* Resolves electronic claim rejections and Explanation of Benefits denials in a timely manner.


* Reviews and researches insurance correspondence and makes necessary corrections to ensure claims payment.


* Follows up on unpaid/unresolved account balances, including claims rejected electronically, EOB denial and working A/R aging reports as directed.

Provides insurance carriers with requested information to facilitate payment.


* Regularly contacts Medicare, Medicaid and /or Commercial payors for resolution to claims not paid or claims not paid according to plan benefits.


* Performs claim appeals as required.


* Assists with credit balance resolution.


* Completes re-bill request as necessary to facilitate timely and proper claims payment.


* Follows up on unresolved account balances including RTP's.


* Prepares adjustment and write-off requests as necessary.


* Performs other duties and responsibilities as required or assigned.