Career Details
Reimbursement Dept Full Time Conkling St Posted on 11/10/2025
Job Description
Reimbursement Special Projects Lead
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JOB SUMMARY |
Coordinating multiple, smaller-scale projects or initiatives related to improving reimbursement processes.
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ESSENTIAL FUNCTIONS |
>Strict adherence to the Company policy and procedure manual including state and federal laws.Ensures compliance with Insurance Companies billing policies and procedures.Works closely with management to collect and lower AR assigned.Oversee all aspects of the Prochant team.Ensure that all assigned procedures, including but not limited to, insurance, denials, re-submittals, inquiries, re-certifications, orders and other paperwork are processed in an accurate and timely manner to ensure claims get paid.Communicates with insurance companies, patients, and other third-party payers regarding reimbursement, coverage, co-payment, deductible, and any pertinent information for account receivable reconciliation. ReportingAR, AR Alpha, Denial, Payment vs Billed, Report Makes recommendations to management for write-offs. May be asked to assist the Reimbursement manager or Director of Reimbursement with day-to-day operations of the Reimbursement Department as assigned by the department manager.Responds to Prochant inquiries in the Prochant pulse portal regarding outsourced A/R.Responsible for training new employees hired for a Reimbursement position.Back-up to Management on completing medical record audits. Track and communicate outcomes of payment or denials from initial orders on high dollar items.Review payments on a weekly basis to ensure proper payment is being made. Works with Reimbursement Coordinators on reporting trends found from reviewing payments and denials.Perform all tasks with available resources before escalating to management. Perform other duties, as assigned.Participates in Performance Improvement activities.Participates in traditional and e-learning programs.Works effectively with other company employees, managers, and departments.Performs all job functions with Company Mission, Vision, and Goal Statements in mind.
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JOB REQUIREMENTS AND QUALIFICATIONS |
Education, Certificate, and Licensure
High school diploma or general education degree (GED); two years Medi-Rents & Sales, Inc. Reimbursement Specialist/Billing Account Rep experience. No professional certificate or licensure required. Minimum of 2 years proficiency with all services the company provides.
Requirements
Must demonstrate proficient ability and practical knowledge of computers, software, and products applicable to the industry. Additionally, the applicant is expected to demonstrate the ability to quickly acquire knowledge of departmental program structure (Mission, Vision, and Goal Statements) and department policies and procedures. Must have the ability to demonstrate effective time management skills while working independently with minimal supervision.
Math Ability
Must demonstrate proficient ability to apply mathematical concepts such as basic algebra and geometry to such tasks as calculating figures and amounts, discounts, interest, commissions, proportions, percentages, area, circumference, and volume to practical situations.
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JOB REQUIREMENTS AND QUALIFICATIONS (CONTINUED) |
Language and Communication Ability
Must demonstrate proficient ability to foster professional working relationships utilizing strong interpersonal and communication skills organization-wide. Applicant must demonstrate the ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, and/or governmental regulations and effectively present and debate any assortment of information relevant to their area of expertise and designated responsibilities and duties with members of the Company and on behalf of the Company when appropriate. Additionally, the applicant must demonstrate the ability to write reports, business correspondence, and procedure manuals.
Physical Demands
Must demonstrate the ability to work in a standard office setting and use standard office equipment, which may include but is not limited to: computers, fax and copy machines, and other office supplies. Requires stamina to maintain attention to detail despite interruptions; strength to lift and carry files weighing up to 10 pounds; vision to read printed materials and a computer screen; hearing and speech to communicate in person and over the phone; manual dexterity to perform job functions and stamina to frequently sit for extended periods of time. Additionally, the employee is occasionally required to walk and lift and/or move up to 50 pounds.
Reasoning Ability
Must demonstrate proficient ability to understand, apply, and interpret an extensive array of information, variables, and instruction where only limited standardization exists to define problems, collect data, establish facts, and draw valid conclusions.
Technology Skills
Must demonstrate proficient ability and practical knowledge of personal computer use, word processing software, spreadsheet software, accounting software, inventory software, internet software, database software, relational databases, statistical packages, project management software and contact management systems. Additionally, the applicant must demonstrate the ability to quickly and proficiently learn to use company specific software programs and any other handheld or technology tools as required for completing job tasks.
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OTHER INFORMATION |
Must demonstrate proficiency and productivity in a fast paced environment with unscheduled interruptions while maintaining acceptable judgment, responsibility, and assumption for decisions, consequences, and results. Applicant must demonstrate good organization, time management, and communication skills. Occasionally an adjusted work schedule is required to accommodate company needs.
This job description has been assessed and found to have no potential risk of occupational exposure to hazardous chemicals, blood, or other potentially infectious materials. However, during the course of some duties it may be necessary to wear personal protective equipment (PPE). Before performing any activity that requires the use of PPE, proper training and certification is required.
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NOTICE |
The statements contained herein reflect general details as necessary to describe the principal functions of this job, the level of knowledge and skill typically required, and the scope of responsibility, but should not be considered an all-inclusive listing of work requirements.