Reimbursement Specialist - Hospital (Full-Time) (Remote Eligible)

Department/Position Details:

• The Reimbursement Specialist will utilize their knowledge when working on accounts receivable, insurance collections, reviewing outstanding balances and provide adjustments as allowed. The position needs a customer-oriented individual with a meticulous eye for details.
• Review and appeal payer denials timely by utilizing work queues.

• Prepare and submit appeals to managed care and third-party commercial payers to recover denied payments. Track and follow up on results of appeals.

• Using the Expected Reimbursement Report developed by Analytics, monitor the accuracy of payments made by the payer.
• Monitor government, commercial and Work Comp payments for accuracy.
• Evaluate information for processing according to office guidelines and procedures.
• Analyze and resolve over-payment by payer or patient and prepare refund request to proper recipient
• Conduct routine accuracy checks of selected data to ensure completeness and accuracy of data. Monitor accounts to ensure appropriate adjustments are made.

• Effectively utilize time to provide efficient customer service.
• Collect, record and audit data to ensure timely and accurate processing of paperwork to maximize reimbursement and achieve improved customer satisfaction.

• Actively participate in achieving team goals, setting priorities, seizing opportunities before being asked, and motivating oneself and others to maximize productivity

• Maintain a high level of knowledge regarding government compliance regulations as well as third-party billing requirements and regulations.
• Maintain up-to-date knowledge of all business office policies and procedures, team goals, department objectives and hospital strategic plans to maximize the decision-making process.
• Demonstrate working knowledge of billing functions on the information system to continue to reduce receivables.
• Evaluate contractual postings to ensure proper billing to secondary payers.
• Maintain current knowledge of private, state, and federal contractual agreements, to ensure proper posting of payments and adjustments.
• Review and initiate correspondence with third party payers to resolve discrepancies.
• Identify, document and report billing system errors.

• Demonstrate communication and problem-solving skills by clearly presenting information and options to patient’s while removing barriers that fail to enhance customer service
• Contact third party and/or patients on unpaid account balances to reduce receivables. Resolve patient questions/complaints through written, verbal communication or through financial counseling
• Maintain confidentiality to protect patient rights and privacy.
• Comply with safety activities, policies and procedures and regulatory requirements such as OSHA and The Joint Commission
• Employee is responsible for all other duties as assigned for which competency has been demonstrated.

Skills:

• Strong communication, including writing, speaking and active listening
• Great customer service skills, including interpersonal conversation, patience, and empathy
• Good problem-solving and critical thinking skills
• In-depth knowledge of industry best practices

Position Requirements:

 Education:

• High school graduate or equivalent required.
• General office experience and Facility Reimbursement experience required.

Experience:

• 2 to 3 years of previous Reimbursement strongly preferred.
• Knowledge of operation (user level) personal computer programs.
• Knowledge of medical terminology preferred.
• Must be able to demonstrate calm, rational thinking and clear communication when faced with deadlines and customer demands.
• Must be capable of responding to frequent priority changes and multiple deadlines.
• Team environment requires total participation by all members in problem solving and decision-making.
• Must be able to work with a multitude of individuals from varying professions and non-professional backgrounds.
• Able to communicate effectively to solve problems at the personal and unit level.

Physical:

• This position is classified as Sedentary Work in the Dictionary of Occupational Titles, requiring the exertion of up to 10 pounds of force occasionally (up to 33% of the time) and/or a negligible amount of force frequently (33%-66% of the time) to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time.