About the job
Job Description:
The Reimbursement Counselor plays a crucial role in ensuring the accurate and timely processing of claims. This includes responsibilities such as submitting claims, monitoring claim status, engaging in collection activities, handling appeals, posting payments, and managing refunds until all accounts receivable matters are resolved effectively.
Key responsibilities include collecting and reviewing patient insurance benefit information within the parameters set by the program's Standard Operating Procedures (SOP). The Reimbursement Counselor also supports physician office staff and patients in completing and submitting necessary insurance forms and program applications.
In addition, the Counselor will complete and submit all required insurance forms and electronic claims to ensure prompt processing by third-party payors. This role involves researching and resolving any electronic claim denials as well.
Effective communication is essential, as the Counselor will maintain regular contact with provider representatives, third-party customer service teams, pharmacy staff, and case managers. The Counselor will report any reimbursement trends or delays to their supervisor, which may include issues like billing denials, pricing errors, or payment discrepancies.
Confidentiality regarding patient account statuses and the financial matters of the clinic or corporation is paramount. The Reimbursement Counselor must communicate accurately with payors and/or claims clearinghouses to ensure timely electronic claim submissions and must coordinate with various departments to obtain relevant medical records as needed.
