Insurance Reimbursement Specialist

Insurance Reimbursement Specialist

Downers Grove, IL

REPORTS TO:         Revenue Cycle Manager


This description includes important information about the responsibilities of the position and qualifications of the employees in the position.  It is intended to service as a general guideline, and not be an all-inclusive list of duties, responsibilities and requirements. Responsibilities, qualifications and requirements are subject to change.


Position Summary:

The Insurance Reimbursement Specialist is responsible for a variety of duties necessary to ensure the smooth operations of the RCM office, including but not limited to contacting insurance companies regarding outstanding account balances, working denied claims, and following up on appeals and resubmitted claims.   Establish and maintain relationships with RCM and non RCM staff.


Primary Responsibilities:


  1. Review daily collection queue for outstanding balances.


  1. Work denied claims/short paid claims and resubmit/appeal as appropriate.


  1. Follow up on accounts receivable aging to ensure that claims are followed up on in accordance with department policy.


  1. Work correspondence from payers.


  1. Submit write off requests when appropriate.


  1. Inform management of issues with fee schedules or changes in payer guidelines.


  1. Assist clinic staff with inquiries regarding account balances.


  1. Review credit balances and submit refund request for processing.


  1. All other duties as assigned by managers and director.



Experience:                            2-3 years’ experience in health care setting, physician office and/or hospital with responsibility for insurance collection functions and followup.


Skills & Abilities:                   Excellent time management and organizational skills with attention to detail.

                                                Knowledge and understanding of medical terminology, ICD-9, ICD-10, CPT-4 and HCPCS coding systems.

                                                Ability to work independently.

                                                Excellent communication skills, both verbal and written.

                                                Ability to multi-task

                                                Ability to problem solve and analyze issues with related to health insurance language

                                                Knowledge and understanding of Managed Care contractual adjustments, electronic remittance format and adjustment/remark codes.

                                                Experience and proficiency in Microsoft Windows, Excel, Word, Adobe.