Reimbursement Specialist

Become a part of our caring community and help us put health first
 

Work Schedule: Full-time/40 Hours

Position Type: Hybrid

Branch Location: Miramar, FL

The Reimbursement Specialist performs research, analysis, documentation, and interpretation for the provider reimbursement programs for an organization that provides health insurance. 

• Reads, interprets, and applies complex payor contract language to expected reimbursement calculations & pursue all payments due to the organization.

• Performs account collection activities utilizing internet resources & professional telephone communication etiquette.

• Composes professional written correspondence with all internal & external entities.

• Creates and submit electronic and paper medical claims with or without patient responsibility.

• Utilizes knowledge in disputing claims with insurance payors effectively.

• Understands insurance health benefits and patient responsibilities to ensure accurate claims processing.

• Handles A/R claims collections and conduct follow-up activities for unpaid claims.

• Interprets remittance advice and explanation of benefits statements.

• Submits appeals for wrongfully paid or denied claims, demonstrating strong grammar skills for effective communication.

• Processes online credit card payments as needed.

• Identifies and escalate problematic collection accounts to management when necessary.

• Resolves billing inquiries and questions from patients and insurance representatives.

• Utilizes Microsoft Office tools, including Outlook, Word, and Excel, to perform job duties efficiently.

Use your skills to make an impact
 

Required Experience/Skills:

• One year or more of healthcare experience, required.

• Home health experience, preferred.

• Basic accounting experience (Accounts Receivable), required.

• Reconciliation experience, required.

• Knowledgeable with HIPPA regulations and compliance requirements, ensuring the protection of sensitive patient information and adherence to privacy standards in all healthcare-related practices.

• Proven experience in medical claims processing, billing, or collections, required.

• Experienced with ICD-10 coding, required.

• Knowledgeable with Microsoft Excel, required.

• Coding and/or billing certification, preferred.

• Bilingual (English and Spanish), required.

• (DME) Medical billing experience, preferred.

Additional Information

• Hybrid (3 days office and 2 from home)
• Location: 3325 Executive Way Miramar, FL 33025
• Over time is required

Scheduled Weekly Hours

40

Pay Range

The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.

$58,700 - $70,400 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.

Description of Benefits

Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.

About Us
 About OneHome: OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients’ homes. OneHome’s patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.

About Humana: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer

It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or veteran status. It is also the policy of Humana to take affirmative action to employ and to advance in employment, all persons regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.