Reimbursement Specialist

Organizational Profile

Founded in 1991, IBJI is the largest orthopedic group practice in Illinois. With more than 150 physicians in every orthopedic specialty, IBJI offers care for adults and children from some of the most accomplished and respected orthopedists in the country. Serving northern Illinois and northwest Indiana with over 100 locations, IBJI makes it easy to access care. Our headquarters is in Park Ridge, Illinois, a northwest suburb of Chicago.

Our clinical services include advanced MRI imaging, pain management, non-surgical and surgical treatment plans, rheumatology, physical therapy, occupational therapy, wellness, and sports and sports training. Ortho Access walk-in clinics provide same day care for orthopedic injuries. Comprehensive care offered all in one place enables physicians, therapists and staff to work closely together, so that patients and families achieve better outcomes. Collaborative care is also more efficient. In many cases, IBJI services are substantially less expensive than those provided by large healthcare systems and emergency rooms.

Job Title: Reimbursement Specialist

Job Description

Summary

The Revenue Reimbursement Specialist works to ensure that we are optimizing insurance collections, reducing outstanding balances, and maintaining the accounts receivables. Revenue Reimbursement Specialists will maximize reimbursement for all services while minimizing the amount of time it takes to obtain reimbursement; decrease AR sustain a low DSO.

Responsibilities

• Communicate directly with the payor, resubmits denied claims, underpaid claims and claims that are inaccurately processed by auditing accounts to check on proper payments, coding, balances, adjustments, etc. using appropriate reports and queues
• Review and analyze claim denials in order to perform the appropriate appeals necessary for reimbursement
• Manage outstanding accounts receivable for assigned payers/Divisions. Resolve outstanding balances
• Follow up on outstanding accounts receivables, 31-60 days, 61-90 days. Includes researching aged account reports, outstanding “list”, processing problematic EOB’s and/or incoming mail or correspondence as identified. Special projects on 90+ days detailing problematic accounts and reporting them to the supervisor
• Identify errors, correct and communicate to management
• Adheres to organizational policies and procedures, including Corporate Compliance Program, HIPAA regulations

Additional Responsibilities

• Conduct random audits to verify system integrity, payer accuracy and payment per contract, to optimize reimbursement functions
• Other duties as assigned
• Focus may be on claims or charges not paid at the correct contract rate
• Maintain a clean and safe work environment