Reimbursement Specialist - Healthcare determines the extent to which patients' insurance covers their treatments. Reviews appropriateness of CPT-4/ICD-10 coding and determines if care provided corresponds to the charges submitted. Being a Reimbursement Specialist - Healthcare ensures compliance with Federal and State regulations and company policies that govern Medicare and state payment systems. May assist in identifying fraudulent non-plan billing practices and assists the legal department with litigation preparation. Additionally, Reimbursement Specialist - Healthcare may require a bachelor's degree. Typically reports to a supervisor or manager. Typically requires Certified Professional Coder (CPC) from AAPC or AHIMA. The Reimbursement Specialist - Healthcare gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. To be a Reimbursement Specialist - Healthcare typically requires 2 to 4 years of related experience. (Copyright 2024 Salary.com)
This is a remote position. This position is for the Governmental team.
Summary: The Insurance Reimbursement Specialist, under the direction of Accounts Receivable Manager, ensures claims submitted to responsible entities are received, processed, and resolved in a timely manner. This position’s goals are met through professional communication, confidentiality and adherence to HIPAA guidelines, and a working knowledge of CMS/other payer guidelines.
Essential Duties and Responsibilities: (List in order of importance or percentage of time spent on the particular responsibility. High to Low)
Qualifications:
Required Education: High school diploma or equivalent
Required Experience: 1 year of experience in healthcare revenue cycle or business office.
Required License/Registration/Certification: None
Reasoning Ability:
Ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to interpret an extensive variety of technical instructions in mathematical or diagram form and deal with several abstract and concrete variables. Use reasoning to meet and maintain department and personal benchmarks.
Computer Skills:
To perform this job successfully, an individual should have knowledge of Word Processing software, spreadsheet software and database software.
Physical Demands:
In order to successfully perform this job, with or without a reasonable accommodation, the following are outlined below:
The Employee is required to read, review, prepare and analyze written data and figures, using a pc or similar and should possess visual acuity.
The Employee may be required to occasionally climb, push, stand, walk, reach, grasp, kneel, stoop, and/or perform repetitive motions.
The Employee is not substantially exposed to adverse environmental conditions and therefore job functions are typically performed under conditions such as those found in general office or administrative work.
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