Reimbursement Specialist Resume Sample

A Reimbursement Specialist usually works in the insurance field to make sure that clients are reimbursed for eligible expenses. Their duties include gathering documentation, reading patient policies, preparing authorization requests, discussing policies with patients, reviewing work, making sure patient receives highest possible reimbursement, conducting benefit investigations, and accurately entering data into system.

For many, writing a resume can be daunting. If you are working on your own, it is easy to become overwhelmed with the amount of information you need to include and how best to present yourself.

The sample resumes below provide great examples of how to write an effective resume.

The Best Reimbursement Specialist Resume Samples

These are some examples of accomplishments we have handpicked from real Reimbursement Specialist resumes for your reference.

Reimbursement Specialist Resume Sample 1

  • Set up and maintained the Accounts Payable system, including scanning in invoices to the system.
  • Processed Requests for Proposals to maintain an effective vendor base.
  • Maintained an automated PO purchasing system through integration of purchase orders, picking lists, receiving reports, shipping notices.
  • Launched new customer claims program resulting in 10% reduction in settlement time.
  • Accomplished 877 percent increase in voluntary settlement offers within first year of implementation by developing comprehensive procedures manual and training staff.

Reimbursement Specialist Resume Sample 2

  • Reviewed insurance claim submissions for completeness and accuracy, resolving rejected claims to the satisfaction of customers.
  • Identified inaccurate denials, claims improperly coded or submitted, billing discrepancies, incorrect product reimbursement rates, and incomplete information on claim forms improving customer service.
  • Ran reports that identified variances in reimbursed amounts compared with what was expected; recommended corrective action to resolve any discrepancies.
  • Produced reports used to identify trends between account pricing and reimbursement; organized data into charts showing variance analysis by date.
  • Tracked annual reimbursements ensuring proper expenditures were made throughout the year; consolidated research results for management review resulting in improved business processes.

Reimbursement Specialist Resume Sample 3

  • Manage the Reimbursement function for a major medical group.
  • Resolved all discrepancies between providers, patients, and insurance companies.
  • Processed reimbursement claims from patient care to carriers within established guidelines.
  • Oversaw the balance of cash in the bank at all times by balancing payables against receivables.
  • Inventoried records on an annual basis following compliance with HIPAA regulations regarding storage and disposal of records.

Reimbursement Specialist Resume Sample 4

  • First Entry-Level Employee to Receive Annual Performance Award.
  • Identified process for decreasing administrative time needed to create check requests by 30% resulting in increased productivity and efficiency.
  • Completed all training courses within one year of employment resulting in awarding of Traveling Telephone/Traveling Secretary position.
  • Initiated new policy requiring doctors to provide completion date for insurance forms prior to billing resulting in a 50% decline in denials allowing reimbursement claim processing times to be decreased from 3 weeks to 3 days.
  • Developed comprehensive manual on Medical Transcription Service Affiliates’ policies, procedures, and standards increasing the effectiveness of patient care department customer service standards tenfold.

Reimbursement Specialist Resume Sample 5

  • Reviewed, analyzed and processed all financial reports through use of the accounting system.
  • Ensured proper documentation was completed in preparation for managed care audits.
  • Supported revenue cycle team by providing data into technical services that allowed resolution of patient account issues in a timely manner .
  • Managed multiple reimbursement contracts through audits and maintained positive working relationships with contract managers to ensure successful outcomes.
  • Conducted research on available healthcare opportunities to provide clients with market analysis and forecast growth strategies.

Reimbursement Specialist Resume Sample 6

  • Reconciled an average of 10 reimbursement files per day for more than 100 days. This resulted in more than 1,500 miscellaneous expenses being reimbursed with a zero balance, saving the company over $28,000.
  • Identified and corrected departmental abuse trends by preparing appropriate documentation to ensure all reimbursements were assigned to appropriate categories on an ongoing basis.
  • Wrote procedures for processing expense reports based on company guidelines; recognized by Supervisor as Employee of the Quarter for high quality work performance.
  • Handled publication orders ranging from single copy sales to large volume sales on a daily basis while maintaining accuracy throughout the distribution process.
  • Acted as liaison between newspaper advertising staff and its outside carriers by coordinating carrier group training sessions, resolving problems with the carriers, and implementing new procedures.

Reimbursement Specialist Resume Sample 7

  • Preformed a variety of billing procedures, including data entry and verification for reimbursement requests.
  • Identified errors in medical documentation according to ICD codes, CPT codes, and diagnosis.
  • Maximized on cost-savings by identifying the least expensive means of treatment for patient’s conditions; submitted new claims with negotiated rates that were more advantageous than regular contract rates.
  • Demonstrated an understanding of third party payers claim adjudication process; identified what information was needed for out-of-network providers to receive reimbursement.
  • Achieved over 99% accuracy rate on all assigned claims; recognized as top performer at awards ceremony.

Reimbursement Specialist Resume Sample 8

  • Solved payment issues by researching possible reasons for rejection of claims, including incorrect medical diagnosis codes, incorrect member numbers, etc.
  • Identified with Medical Director out-of-network providers in order to negotiate better reimbursement rates with insurance companies.
  • Received appreciation from external customers in the form of customer satisfaction surveys upon successfully resolving billing problems that were caused by inaccurate provider information due to state policy changes.
  • Obtained new accounts through networking with local hospitals and community medical centers.
  • Achieved department goal of ensuring all errors are corrected within two business days or less after discovering error correction was not mandated until 6 months later. Emphasized need for corrective action during quarterly management meeting.

Reimbursement Specialist Resume Sample 9

  • Verified patient eligibility for coverage, managed claims through the subrogation process to ensure reimbursement of benefits; identified missing documents and follow up with providers to ensure accuracy.
  • Manage company communications with doctors offices using CPC, CPC+, EPIC, EDS, RAPS & MYWAY software applications.
  • Solved difficult insurance queries by working closely with clinicians and clinicians’ office staff.
  • Effectively investigated denials on a daily basis utilizing EDI system to provide alternate solutions in a timely manner.
  • Negotiated claims against Medicare Secondary Payer (MSP) guidelines as well as State MSP regulations tracking complex multi-state issues across multiple payers resulting in millions of dollars in reimbursement for the organization.

Reimbursement Specialist Resume Sample 10

  • Ensured all medical bills were approved before moving to the next step within the claims process.
  • Reviewed and adjusted patient accounts that contained errors due to coding, billing or benefits.
  • Assisted with locating departmental supplies including but not limited to pens, paper, envelopes, etc.
  • Tracked down missing member information for proper enrollment in insurance plans.
  • Managed files of subrogation cases filed against other insurers on behalf of members wrongfully denied coverage by contemporaries. Processed research requests under time constraints while maintaining confidentiality of customer records.

Reimbursement Specialist Resume Sample 11

  • Key contributor in exceeding company goals and objectives.
  • Achieved superior performance appraisal by optimizing cash flow of $2.7 million, while minimizing accounts payable turnover of $5.0 million.
  • Oversaw and allocated over $12 million in account payments and utilized reconciliation procedures to ensure accurate payments for all invoices processed.
  • Streamlined the reimbursement process for finance by revising internal controls to increase productivity, accuracy, timeliness, and accessibility of information through the use of online databases. Developed monthly reports on user activity to minimize security risks within the network environment.
  • Created user-friendly computer programs that allowed quick access to critical records stored in multiple locations and quickly obtained and analyzed payment information saving time and money.

Wrap Up

A High School diploma is required for this job, but a Bachelor’s degree is strongly preferred. Skills needed are strong communication skills, team player skills, critical thinking skills, detail orientation, proficiency in MS Office, ability to meet deadlines, and ability to handle many priorities at once.

Resumes are a crucial aspect of any job search. In order to make a good first impression, it is important that your resume be formatted and written professionally. To create the perfect resume, think about what skills and qualities you want your future employer to see.

Hope these samples gave you an idea of what your resume should look like and some tips on how to make sure that your resume stands out from the rest.

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