Reimbursement Representative at U.S. Renal Care in Plano, Texas

Job Description:

U.S. Renal Care is seeking a Reimbursement Representative for our dialysis facilities. The Reimbursement Representatives role is to file insurance claims and collect on accounts assigned in a timely and accurate manner.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following:

• Reviews EOB/EOMB's for proper reimbursement.
• Responsible for all collection activities on identified accounts.
• 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.
• Monitors all contracts and single patient agreements to ensure that appropriate reimbursement is received.

EDUCATION and/or EXPERIENCE: