Reimbursement Specialist Resume Sample
Stone Keeling
3028 Balistreri Vista,
Phoenix,
AZ
+1 (555) 503 4274
Work Experience
Reimbursement Specialist
08/2017
-
PRESENT
Dallas, TX
- Professional representation of manufacturer’s patient and physician access services
- Provide information on relevant access topics related to our client’s products
- Reviewing patient-specific information in cases where the site has
- Current, unrestricted driver’s license in state of residence
- Demonstrated proficiency with Microsoft Word, PowerPoint and Excel; current driver’s license and safe driving record; use of computer, mobile phone, printer and fax
- Accurately enter and maintain data as required in client database and patient files and utilize the client database to monitor outstanding items on each client case file. Ensure files are complete so team can determine the current status
- Participate in conference calls with Client Sales Representatives, client management and physicians’ offices regarding status of cases, drug orders and status of alternative funding
Senior Reimbursement Specialist
07/2010
-
02/2017
Chicago, IL
- Provide coordination of order for product, shipment of product, and therapy initiation with pharmacy and patient
- Identify and report events as required by the REMS requirements for specified medication. Recognize adverse event, product quality complaint and potential risk events and forward information to the appropriate team member for reporting to the manufacturer
- Educate patients, prescribers, and others regarding program requirements, and facilitate referrals. Maintain good housekeeping techniques, adhereing to quality and production standards and comply with all applicable company, state, and federal safety and environmental programs and procedures
- Obtain and retain Pharmacy Technician License per state guidelines
- Conduct benefit investigations, verify
- Obtain recertification for cases requiring extended treatment/coverage beyond the expiration of original approval
- Accurately enter and maintain data as required in client database and patient files and utilize the client database to monitor outstanding items on each client case file
Field Reimbursement Specialist
07/2007
-
02/2010
Philadelphia, PA
- Ensure files are complete so team can determine the current status
- Participate in Call Center Activities, triage and respond to incoming calls from patients, insurance companies, physicians, Sales Reps, pharmacies and homecare agencies
- Identify and report events as required by the REMS requirements for specified medication
- Recognize adverse event, product quality complaint and potential risk events and forward information to the appropriate team member for reporting to the manufacturer
- Educate patients, prescribers, and others regarding program requirements, and facilitate referrals
- Maintain good housekeeping techniques, adhereing to quality and production standards and comply with all applicable company, state, and federal safety and environmental programs and procedures
- Excellent written and verbal communication skills, with demonstrated ability to communicate with others at all levels
- Manage multiple priorities and meet deadlines. Detail oriented with good analytical skills
Education
Herzing University Madison
2002 - 2007
School's Degree in Business
Professional Skills
- Strong organizational skills; able to effectively prioritize work on a daily basis and follow up on open items in a timely manner
- Strong computer skills, including expertise in database management; advanced proficiency in MS Office applications
- Strong interpersonal and writing skills required in order to communicate both verbally and in writing with external and internal stakeholders
- Excellent interpersonal and communication skills to positively interact with a variety of personnel, in a fast-paced environment
- Team Building: Demonstrate solid skills in working with a large diverse workforce in a a complex operating environment
- Effective communication demonstrated through professional written and verbal skills
- Killed Nursing Medicare billing experience
How to write Reimbursement Specialist Resume
Reimbursement Specialist role is responsible for analytical, microsoft, organizational, interpersonal, database, customer, medical, government, insurance, coaching.
To write great resume for reimbursement specialist job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Reimbursement Specialist Resume
The section contact information is important in your reimbursement specialist resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Reimbursement Specialist Resume
The section work experience is an essential part of your reimbursement specialist resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous reimbursement specialist responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular reimbursement specialist position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Reimbursement Specialist resume experience can include:
- Effective at gaining the support and dedication of others by engaging them around your point of view and priorities
- Superior analytical, planning, problem solving, organizational, oral/written communication, and PC (Word/Excel) skills are all essential
- Demonstrates experience/knowledge to accurately bill third party contracts/governmental payers to the specific requirements
- Read and follow procedure manuals, ability to write routine reports, ability to speak effectively before groups of customers or employees
- Demonstrate teamwork by assisting coworkers with tasks/training as directed, and attending and participating in mandatory meetings
- Demonstrate the ability to read, retain and assist in implementing billing guideline changes at payer specific levels
Education on a Reimbursement Specialist Resume
Make sure to make education a priority on your reimbursement specialist resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your reimbursement specialist experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Reimbursement Specialist Resume
When listing skills on your reimbursement specialist resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical reimbursement specialist skills:
- Strong problem-solving skills with the ability to resolve issues effectively and efficiently
- Organized work habits, proven attention to detail with strong analytical skills
- Effective organizational/communication/negotiating skills and the ability to focus on work detail also required
- Demonstrates effective problem solving and excellent customer service
- Excellent customer service skills including oral and written communication
- Effective communication and interpersonal skills- concise, persuasive, diplomatic, instructive, both written and oral
List of Typical Experience For a Reimbursement Specialist Resume
1
Experience For Senior Reimbursement Specialist Resume
- Experience within a healthcare environment. Medical claims experience
- Experience within the healthcare environment. Medical claims experience
- Experience; experience with a
- Strong understanding of: Orthopedic, ENT, Surgical Coding/Billing
- Validate that Epic is pricing correctly once loaded, pricing issues brought to Contract Specialists attention
- Provide excellent customer service, including problem solving and timely follow up
- Experience in reading and comprehending Insurance Carrier EOB
2
Experience For Cerner Reimbursement Specialist Resume
- Excellent written/verbal communication to include providing clear instructions
- Illustrate excellent knowledge of healthcare industry in regard to the revenue cycle, coding, claims and state insurance laws
- Experience working in a Reimbursement Specialist positions
- Establish and maintain effective working relationships with payers
- Previous experience in launching new Specialty Pharmaceutical/ Biologics products or indications
- Individual needs to have in depth understanding of managed care delivery systems and have had direct experience with reimbursement
3
Experience For Field Reimbursement Specialist Resume
- Healthcare Practice Management or Medical Billing experience
- Experience in the insurance, biotechnology, or pharmaceutical industries
- Run log variance reports 2,3,4,5 and autocarp daily as needed to identify and quantify variances that exist for each facility and prioritize work accordingly
- Verify eligibility and benefits of plan coverage and prior authorization process for payer
- Review accounts previously validated to ensure proper reimbursement
- Demonstrates thoroughness with all work related activities. Strive to continually improve quality and productivity results
- A/R Follow Up experience required
4
Experience For Reimbursement Specialist UBC Resume
- Good working knowledge of the claims pricing system and the ability to research and resolve issues
- Experience with various claim types, systemic pricing methods, and appropriate configuration methods to ensure claim accuracy
- Seven years experience with a physician practice, hospital, ancillary provider, health insurance company or integrated delivery system is required
- Industry experience (3rd party payer or DME provider) required
- Knowledgeable and proficient in the entire prior authorization and appeals process for prescriptions medications, infusions, medical procedures and devices
- Medicare Advantage Plan experience
5
Experience For Ubc-field Reimbursement Specialist Resume
- Two years health insurance industry experience
- Medical business office or pharmacy technician experience
- Industry experience (Third Party Payer or DME provider) required
- Experience in the insurance,
- Experience in the insurance, biotechnology, or pharmaceutical industries; customer service and/or reimbursement
- Posting and reconciling insurance/patient payments
- Working knowledge in insurance billing guidelines and requirements
6
Experience For N Reimbursement Specialist Resume
- Completing claims worklists assigned by Reimbursement Supervisor
- Filing appeals when appropriate to obtain maximum reimbursement
- Billing Position is a self-directed function under direct supervision of Director/Manager and/or designee
- Handling other reimbursement related functions as assigned
- Posting accuracy- ensure all payments and contractuals are posted accurately
- Documenting account actions
- Understanding of local regulatory policy
- Responsible for performing all of the billing and collection activities for assigned programs, ensuring timely and accurate billing including
7
Experience For Orange County / Reimbursement Specialist Resume
- Provide support and training to the Cook sales and marketing teams in addressing coding and reimbursement issues
- Specific training related to CPT procedural coding and ICD9 CM diagnostic coding through continuing education programs/ seminars and/or community college
- Supports billing and practice management support team with internal coding, pricing and fee schedule analysis and provide updates and recommendations
- Identifies and corrects any claim processing errors due to data entry, verification, coding and/or posting mistakes. Ensures accounts are properly documented
- Performs all patient accounting functions related billing and verifies billing based on provider/client requirements
- Review of Denials including writing appeals and facilitating their submission
- Identify and resolve reimbursement issues to facilitate pharmacy processes including prescription processing and invoicing
- Assists with processing of claims accurately and timely and/or performs collection calls and is persistent with aging accounts
- Prepare and maintain Excel Training Report of all training activities completed per employee
8
Experience For Austin / Reimbursement Specialist Resume
- Maintain the learning pod documentation keeping it current
- Shows ability to interpret account information accurately and communicate variances relating to contractual/billing issues
- Performs healthcare information and medical claims processing, healthcare billing and collection services
- Responds to inquires regarding reimbursement issues including ABN's, insurance determination and payment
- Consistently follow up on unpaid claims utilizing monthly aging reports
- Support organization’s training and implementation of ICD-10 coding
- Researches denied and improperly processed claims by contacting assigned carriers to ensure proper processing of said claims
- Excels in learning and applying new processes/procedures
9
Experience For Senior Reimbursement Specialist, Case Manager Resume
- Partner with market access, marketing, regulatory and pricing colleagues at reimbursement relevant topics
- Responsible for reviewing existing charges, CPT and Revenue codes on the CDMs to remain compliant with industry regulations and positive sustainability
- Supports informational needs relating to contract negotiations and the practical application of contracts in securing appropriate reimbursement
- Collect outstanding balances while promoting the Company’s reputation for integrity
- Make outgoing calls to customers with outstanding balances
- Comply with all state and federal regulations regarding debt collection, including the Massachusetts Fair Debt Collection Law
- Assist with HP vendor relations involving meetings, financial data reporting, and payments
- Attend meetings requiring representation by reimbursement department, including external meetings with hospital representatives or officers
- Communications with all provider types in order to resolve claims issues including reimbursement, coding, and system configuration
10
Experience For Regional Reimbursement Specialist Resume
- Special projects as required, utilizing claims system knowledge and spreadsheet applications incorporating advanced use of Excel and / or Access
- Reviews and enters billing or collection activity to accounts receivables associated with claims submissions and follow-up post billing
- Process files not following the standard reimbursement process, including, but not limited to: Critical Needs, Tricare for Life, Workers Comp and VA
- Proficiency in Microsoft Office, including a working knowledge of Microsoft Word and Excel and Web-enabled applications
- Proficiency in Microsoft Office, including a working knowledge of Microsoft Word and Exceland Web-enabled applications
- Monitors processing of denials and secondaries to ensure prompt follow up
List of Typical Skills For a Reimbursement Specialist Resume
1
Skills For Senior Reimbursement Specialist Resume
- Strong analytical skills with an emphasis on computer/spreadsheet skills
- Excellent organizational and detail oriented skills
- Solid Microsoft Office skills (Excel, Word, PowerPoint)
- Professionalism, good judgment and time management skills required
- Strong knowledge base of multiple billing areas/functions. Solid knowledge base of Specialty Infusion billing is required
- The ability to operate independently, utilizing past extensive reimbursement experience and judgment, is essential
2
Skills For Cerner Reimbursement Specialist Resume
- Demonstrates experience and knowledge of third party and governmental payers
- Two to three years related experience in medical/billing reimbursement environment, or equivalent combination of education and experience
- Three to four years related experience in medical/billing reimbursement environment, or equivalent combination of education and experience
- Effectively provides direction to regional PFS Departments in regards to payment discrepancies by properly documenting system accounts for payment resolution
- Hosp/phys business office w/demonstrated ability in one or more functional areas of the Bus. Off., or similar other office experience
- Interact effectively, appropriately, and professionally with clients, other departments, and management personnel
- Experience within a healthcare environment. Medical claims experience. Medicaid AR Collections
3
Skills For Field Reimbursement Specialist Resume
- Quick and accurate Alpha/numeric data entry skills
- Demonstrate excellent customer service that promotes patient, staff and customer satisfaction, and reflects the Mission, Vision, and Values of Nemours
- Working knowledge of PC with experience in other word processing or spreadsheet applications
- One year experience working in a professional office setting
- Validate PCON is pricing correctly once loaded, pricing issues brought to Contract Specialists attention
- Experience in medical billing of medical claims processing
- Apply in depth knowledge of coding principles to validate missing or incomplete CPT, HCPCS, or IDC-10 codes
- Communicate and educate patients regarding their private drug coverage and options, including status of Prior Authorization requests
4
Skills For Reimbursement Specialist UBC Resume
- Strong knowledge in request/preparation of supporting documents such as medical records, dictation, appeal letters, and contract pages
- Demonstrated knowledge in ICD/9, CPT, HCPCS coding
- Experience with Medicare, Medi-Cal and GHPP Medical billing
- Demonstrates a basic understanding of the business
- Demonstrate a clear understanding of compliance policies for Hill Rom and both government and commercial insurances
- Experienced in using reference materials: CPT, ICD9, HCPCS, CMS Guidelines, NCCI and Anesthesia reference materials
5
Skills For Ubc-field Reimbursement Specialist Resume
- An experienced professional with a full understanding of area of specialization; resolves a wide range of issues in creative ways
- Experience in patient assistance, healthcare reimbursement, insurance or benefits
- Experience in pre-authorizations or Medicare/Medicaid applications
- Demonstrated attention to detail and adherence to productivity and accuracy standards
- Experience with management and resolution of items in the MGRHOLD Bucke
- Experience with AthenaCollector and Anodyne
- Related experience with Hospital medical billing and follow-up
- Demonstrates knowledge of UB/1500 and other requirements at the payer specific level
6
Skills For N Reimbursement Specialist Resume
- Experience with either a physician practice, hospital, ancillary provider, health insurance company or integrated delivery system is required
- Experience with Medical and Pharmacy insurance eligibility, benefits and authorizations
- Experience in Health Insurance Billing / follow up Billing
- Experience collecting from Government Payors
- Experience with patient account billing systems
7
Skills For Orange County / Reimbursement Specialist Resume
- Good understanding of the A/R process within health insurance
- A proactive mentality and the strong ability to solve challenging situations
- Recognize and research unusual variances from prior year to ensure that information is being reported properly
- Reviews accuracy of insurance verification, delivery ticket items, and service dates prior to billing
- Previous experience working with tax advantaged benefit plans
8
Skills For Austin / Reimbursement Specialist Resume
- Accounting and/or reimbursement experience
- Strong organizational and training abilities
- 4+ years related experience with reimbursement assistance or third-party billing
- Experience in healthcare, reimbursement with focus on intake, insurance verification, authorization and billing and collections functions
- Strong business, operational, and procedural knowledge of call center environment
- Four years healthcare related business office experience
- CPR+ application experience
- 3+ months work experience
- Experience with California payers
9
Skills For Senior Reimbursement Specialist, Case Manager Resume
- Able to prioritize work daily
- Customer service focused, with demonstrated ability to respond to external clients’ emailed requests in a timely and professional manner
- Demonstrate proficiency in Excel and other MS products
- Experience in the healthcare , pharmaceutical or insurance industry is an asset
- Strong written, verbal and interpersonal communications
- Experience with Total Information Management System (TIMS) a benefit
- Three+ years’ experience in healthcare revenue cycle management and extensive knowledge of insurance reimbursement policies
- Experience within a healthcare environment
10
Skills For Regional Reimbursement Specialist Resume
- Operate data entry keyboard and 10 key calculator
- Exhibit excellent work ethic and commitment to job responsibilities
- Demonstrates ability to organize and plan daily work with outcome-based criteria in mind
- Experience that includes familiarity with CPT and ICD-10 resources
- Actively seeks additional experience and knowledge across all functional areas to gain expertise
- Industry experience (3rd party payer or DME provider) required
- Demonstrate professional conduct with both internal and external customers
List of Typical Responsibilities For a Reimbursement Specialist Resume
1
Responsibilities For Senior Reimbursement Specialist Resume
- Learn processes for multiple products and effectively apply learnings to provide effective reimbursement services
- Computer skills with emphasis on excel, spreadsheets, and word processing
- Strong experience with MS Excel/MS Word/10-Key pad by touch
- Communicate and coordinate effectively with internal and external contacts
- An effective communicator, capable of figuring out how best to reach different audiences and executing communications based on that understanding
- Skilled at building partnerships and working as a team to meet shared objectives and goals
2
Responsibilities For Cerner Reimbursement Specialist Resume
- Demonstrates a knowledge of electronic billing software focus on ePremis Job Requirements
- Two years' of work experience in Physician, Home Health and Hospice Coding
- Experience in the insurance, biotechnology, or pharmaceutical industries
- Demonstrated commitment to improve patient care
- High level experience with MS Office suite programs
- Experience payor policies to include all areas of reimbursement, medical policy and payor appeal requirements
- Acts as a liaison with external third party payer (insurance) representatives to validate and correct information
- 1 ~ 2 years prior successful collection activity and reduction in DSO
- Be self~directed and work independently.Ability to identify and set priorities
3
Responsibilities For Field Reimbursement Specialist Resume
- Demonstrated knowledge in self-pay and mandated charity laws
- Acts as a liaison with external third-party payer (insurance) representatives to validate and correct information
- Healthcare experience
- Experience payor policies to include all areas of reimbursement, medical policy and payor appeal requirements
- Ales or reimbursement experience
- Specific knowledge of specialty pharmacy and provider interactions Required-Buy and Bill Experience
- Experience with clerical re-openings and re-considerations also required
- Experience in client relations or account management
- Plan, organize and maintain priorities & schedules to ensure deadlines are met
4
Responsibilities For Reimbursement Specialist UBC Resume
- Achieving Results – Is goal directed and persistent; is accountable for meeting commitments; recognizes the contributions of peers
- Taking and posting patient payments
- Working with Billers to resolve billing issues
- Managing the daily workload of all pended claims and claims issues received from outside of the reimbursement department
- Composing letters to explain reason for appeal
- Answering patient questions and concerns
- Assisting patient with Bronson My Chart
5
Responsibilities For Ubc-field Reimbursement Specialist Resume
- Working knowledge of Epicor
- Working knowledge of worker’s compensation, urgent care and clinical procedures/processes
- Working knowledge of diagnoses and commercial payers
- Understanding of managed care from either the retail pharmacy of PBM perspective
- Handling mail return
- Documents findings by writing inquiry letters, constructing opinion letters, maintaining contract files, and maintaining files for research documents
- Identify and correct any claim processing (data entry, verification, coding and/or posting) errors. Ensure accounts are properly documented
- Responsible for reviewing, interpreting and reacting to data provided by clients and customers
- Enter customer demographics and orders into the billing system including all information necessary for billing
6
Responsibilities For N Reimbursement Specialist Resume
- Closely monitor the timely filing guidelines of all payers to ensure that outstanding claims are billed within the payers timely filing period
- Reviews and resolves coding issues with clinical, business office and contracting staff
- Collaborates in the development of training programs, initiatives, and work flows to support clinical coding and guidelines
- Assist other ACs with workloads, including outstanding Verification of Benefits and Outcomes Calls
- Ensures supplemental billing for any late entries is sent to payer within payer filing limits
7
Responsibilities For Orange County / Reimbursement Specialist Resume
- Reduces delinquent accounts and achieving maximum collections from all payer sources by contacting or follow up with the appropriate payer
- Involved in preparing the initial cost report filing as well as resubmission of any previously filed cost report that requires adjustment
- Prepare all necessary supporting documentation to be included with the filing
- Enrollment & billing (including reconciliation)
- Researches available alternative funding options to reduce patient’s financial burden
- Researches available alternative funding options to reduce patient's financial burden
- Generate claims within the billing system
8
Responsibilities For Austin / Reimbursement Specialist Resume
- Update system with corrected patient or claims mailing addresses as needed
- Prepare paper medical claim forms for mailing
- Participate in Billing Team meetings and AR related payer focus meetings
- Facilitates appropriate clinical coding to support diagnosis capture, specificity, and accuracy
- Provide analysis and updates for CPT, HCPCS, CCI edits, Medicare Fee Schedule, commercial payer and Workers Comp coding changes
- Charge Master/fee schedule review, analysis and recommendations including fee schedule methodology
- Provide pricing projections for private payors, Medicare and Workers Comp
9
Responsibilities For Senior Reimbursement Specialist, Case Manager Resume
- Monitor guidelines and any new information in the CPT, HCPCS and ICD-10 coding
- Contribute to the overall team effort by working with all members and all levels of personnel in various locations throughout the company
- At least one of the following credentials required: CPC, CCA, CCS, CCS-P
- Conduct analytical research and provide expertise on items; such as; pricing, reimbursement, and claim appeals process
- Manage the up-keep of denial reports and ensuring accounts are properly documented
- Receive updated workers compensation information from patient’s daily and call insurance carrier to verify the claim number and billing address
- Maintain current working knowledge of Medicaid Eligibility and Enrollment
- Maintain spreadsheet of dollars recovered using excel
- Update and/or creating new CRB (contract resource book.) sheets for all managed care payors and distribution to various internal departments
10
Responsibilities For Regional Reimbursement Specialist Resume
- Assist with clinical trials by providing research sites with COOK’s Medicare reimbursement packet and guidance
- CMS 1500 form billing
- To have an in-depth understanding of national reimbursement system in Turkey (SUT and MEDULA)
- Prepare and follow-up reimbursement applications to Social Security Institution according to Medical Device Application Guidelines
- Continuously monitors health policy developments regarding reimbursement and inform relevant internal and external stakeholders
- Collaborate with regional/global reimbursement teams internally to ensure knowledge sharing
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