Medical Reimbursement Technician

Full Job Description

Employee will be assigned to the Consolidated Patient Account Center (CPAC), Chief Operating Officer (COO), Billing and Insurance Verification Department, Lebanon, PA, performing a broad range of duties to achieve the established and expected results for medical billing and reimbursable and non-reimbursable collections.

SPECIALIZED EXPERIENCE-GS5: Applicants must possess at least one (1) year of specialized experience that equipped them with the particular knowledge, skills, and abilities to perform successfully the duties of this position, and that is typically in or related to the work of this position.

To be creditable, this experience must have been equivalent to at least the GS-4 level in the Federal service.

Specialized experience includes: working in a medical billing environment for healthcare reimbursement and accounts receivables; verifying patient insurance coverage and eligibility; collecting from third party insurance companies; and coding actions utilizing International Classification of Diseases (ICD-9) and Current Procedural Terminology (CPT/4) diagnostic codes.

OR SUBSTITUTION OF EDUCATION FOR EXPERIENCE (Transcript Required): Successful completion of (4) years of education above the high school level.

This education must have been obtained in an accredited business, secretarial or technical school, junior college, college or university for which high school graduation or the equivalent is the normal prerequisite.

One year of full-time undergraduate study is defined as 30 semester hours, 45 quarter hours, or the equivalent in a college or university or at least 20 hours of classroom instruction per week for approximately 36 weeks in a business, secretarial or technical school.

OR COMBINING EDUCATION AND EXPERIENCE (Transcript Required): Combination of successfully completed post high school education and experience may be used to meet total qualification requirements.

SPECIALIZED EXPERIENCE-GS6: Applicants must possess at least one (1) year of specialized experience that equipped them with the particular knowledge, skills, and abilities to perform successfully the duties of this position, and that is typically in or related to the work of this position.

To be creditable, this experience must have been equivalent to at least the GS-5 level in the Federal service.

Specialized experience includes: working in a medical billing environment for healthcare reimbursement and accounts receivables; verifying patient insurance coverage and eligibility; collecting from third party insurance companies; coding actions utilizing International Classification of Diseases (ICD-9) and Current Procedural Terminology (CPT/4) diagnostic codes; and auditing accounts.

PHYSICAL REQUIREMENTS: The work may require some physical effort such as periods of standing, walking, or bending. There are no special physical demands.

For more information on these qualification standards, please visit the United States Office of Personnel Management's website at https://www.opm.gov/policy-data-oversight/classification-qualifications/general-schedule-qualification-standards/.

Major Duties:

***THIS IS NOT A VIRTUAL POSITION, YOU MUST LIVE WITHIN OR BE WILLING TO RELOCATE WITHIN A COMMUTABLE DISTANCE OF THE DUTY LOCATION*** This position involves a multi-grade career ladder.

The major duties listed below represent the full performance level of GS-6. At the GS-5 grade level, you will perform assignments of a more limited scope and with less independence.

You will progressively acquire the background necessary to perform at the full performance level of GS-6.

Promotion is at the discretion of the supervisor and is contingent upon satisfactory performance, availability of higher-level work, and availability of funds.

Duties include, but may not be limited to the following: Performs verification of patient insurance coverage.

Obtains patient insurance information through automated databases, direct patient contact and contact with insurance companies.

Verifies benefits, policy number, pre-certification requirements, and effective dates of coverage. Updates and maintains patient information in an electronic database.

Generates monthly reports as required. Ensures that all billable cases are identified and that bills are accurately generated.

Validates claims for billing purposes, ensuring eligibility, and referring questionable coding for review. Tracks, reviews, and corrects denials.

Obtains required information and coordinates completion of forms with patients, staff, and providers.

Responds to patients' questions, explaining eligibility requirements, insurance provisions, and billing and payment procedures.

Performs third party collection from insurance companies and accounts receivable functions. Verifies the accuracy of payments, resolves problems and discrepancies, and closes out accounts.

Performs other related duties as required. Work Schedule: Monday - Friday, 8:00am - 4:30pm.

Recruitment & Relocation Incentives: Not authorized Telework: This position may be authorized for ad-hoc telework. Ad-hoc telework eligibility will be discussed during the interview process.