Reimbursement Specialist - Healthcare jobs in Springfield, IL

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)

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Reimbursement specialist
  • SIU HealthCare
  • Decatur, IL FULL_TIME
  • Description

    The primary purpose of this position is to be respsonsible for ICD-10 and CPT coding of services provided by physicians and mid-level providers for all outpatient and inpatient services for Decatur SIU Center for Family Medicine.

    This position reviews charges to ensure documentation is appropriate for the CPT level of service indicated. In addition, the employee is responsible to ensure that theTeaching Physician Guidelines are accurately documented by the provider.

    Hours : As needed

    There are no benifits associated with this position

    Examples of Duties

    70% Coding

    1. Assign ICD-10 and CPT codes for services provided at the Decatur SIU Center for Family Medicine clinic.

    2. Through periodic audit reviews and utilizing the electronic health record, determine that chart documentation supports services indicated on encounter form, and teaching physician supervision involvement requirements are met for resident services.

    3. Bring discrepancies to the attention of the physicians and other providers to resolve coding issues.

    4. Perform review on charge tickets and encounter forms and recommends needed changes.

    5. Teach residents appropriate coding practices, familiarity with inpatient and outpatient levels and the requirements of same.

    6. Review denied claims for coding errors, and corrects and / or provides chart documentation for re-submittal for claims payment consideration.

    7. Keep abreast of Medicare and Medicard regulations as they apply to the teaching physician guidelines.

    8. Code off-site services (Public Hlth Clinics, Nursing Home, Home Visit, etc.) by the Providers and ancillary personnel.

    9. Attend monthly Billing and Coding User Group meetings.

    30% Billing / Posting

    10. Hospital Inpatient : This position works directly with faculty attendings to ensure Proper billing of hospital services.

    This requires a verification system to make sure that double billing does not occur since the attending changes frequently.

    In addition, follow-up on deliveries and newborns is required to ensure services are billed.

    11. Periodically audit chart notes to determine all appropriate charges were billed and notes are completed on a timely basis report discrepancies to the Supervisor.

    12. Reviews, in detail, completed encounter forms and posts charges for physician Services using practice management system.

    13. Works TES edits to make sure adjustments are made to posted batches as required by Claims Manager claims scrubber.

    14. Reconciles discrepancies by processing end of day reports.

    15. Work and process the outstanding encounter report, bringing overdue charges to the attention of the Supervisor.

    16. Assist the Supervisor in completing the open encounter report.

    17. Assist the Supervisor in training residents, faculty and nurses on the specialized FQHC billing and coding procedures.

    Qualifications

    2. Current certification as a Certified Coding Specialist (CCS) or Certified Coding Specialist?Physician-based (CCS-P) or Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) by the American Health Information Management Association (AHIMA), or current certification as a Certified Procedural Coder (CPC) or a Certified Procedural Coder-Hospital (CPC-H) by the American Academy of Professional Coders (AAPC).

    3. One (1) year / twelve (12) months of work experience comparable to that performed at the Reimbursement Coding Representative level of this series or in other positions of comparable responsibility.

    Condition of Employment : Pursuant to the State Universities Civil Service System, an out-of-state resident who is hired into this position must establish Illinois residency within 180 calendar days of their start date.

    Supplemental Information

    If you require assistance, please contact the Office of Human Resources at or call 217-545-0223 Monday through Friday, 8 : 00am-4 : 30pm.

    The mission of Southern Illinois University School of Medicine is to optimize the health of the people of central and southern Illinois through education, patient care, research and service to the community.

    The SIU School of Medicine Annual Security Report is available online at . This report contains policy statements and crime statistics for Southern Illinois University School of Medicine in Springfield, IL.

    This report is published in compliance with Federal Law titled the

    Jeanne Clery Disclosure of Campus Security Policy and Crime Statistics Act."

    Southern Illinois University School of Medicine is an Affirmative Action / Equal Opportunity employer who provides equal employment and educational opportunities for all qualified persons without regard to race, color, religion, sex, national origin, age, disability, sexual orientation, protected veteran status or marital status in accordance with local, state and federal law.

    Pre-employment background screenings required.

    Last updated : 2024-03-05

  • 21 Days Ago

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Reimbursement Specialist
  • Cancer Care Specialists Of Illinois
  • Decatur, IL FULL_TIME
  • SUMMARY: Under the general supervision of the Director of Business Office Services, the Reimbursement Specialist- Cash Posting Specialist is responsible for managing patient balances, accurately and t...
  • Just Posted

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Reimbursement Coding Specialist (U)
  • SIU Medicine
  • Springfield, IL FULL_TIME
  • Overview: The primary purpose of this position is to assign ICD-10-CM, CPT, and HCPCS codes for inpatient and outpatient services by reviewing medical records documentation for those services provided...
  • 24 Days Ago

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Reimbursement Specialist (Medical Billing)
  • CANCER CARE SPECIALISTS OF ILLINOIS
  • Decatur, IL OTHER
  • Job Details Level: Experienced Job Location: CCSI Decatur - Decatur, IL Position Type: Full Time Education Level: High School Salary Range: Undisclosed Travel Percentage: Negligible Job Shift: Day SUM...
  • 1 Day Ago

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Reimbursement Specialist (Medical Billing)
  • Cancer Care Specialists Of Illinois
  • Decatur, IL FULL_TIME
  • SUMMARY: Under the general supervision of the Director of Business Office Services, the Reimbursement Specialist is responsible for timely billing functions, including posting of charges, electronic a...
  • 8 Days Ago

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Reimbursement Coding Specialist (U) (Hybrid/PRN) (Decatur)
  • SIU Medicine
  • Decatur, IL FULL_TIME
  • Department: Family and Community Medicine/Decatur-SMS Division: NA Location: Decatur Job Category: Office Support Overview: The primary purpose of this position is to be respsonsible for ICD-10 and CP...
  • 24 Days Ago

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0 Reimbursement Specialist - Healthcare jobs found in Springfield, IL area

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Healthcare Coding Associate
  • Taylorville Memorial Hospital
  • Springfield, IL
  • Overview The Healthcare Coding Associate will code outpatient diagnostic medical records utilizing ICD-9-CM, ICD-10-CM a...
  • 3/29/2024 12:00:00 AM

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Director of Hospital Business Office - $10,000 Sign On!
  • Universal Health Services
  • Springfield, IL
  • Responsibilities $10K sign-on bonus! The Business Office Director manages and directs the activities of the Business Off...
  • 3/29/2024 12:00:00 AM

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Follow Up Specialist
  • Memorial Health
  • Springfield, IL
  • Overview: Follows up on outstanding payments due on all types of open medical insurance claims, i.e., managed care and c...
  • 3/28/2024 12:00:00 AM

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Customer Account Specialist (CSR)
  • Corporation Service Company
  • Springfield, IL
  • Job Description Are you passionate about delivering exceptional service? Us too. Customer Service Representative Springf...
  • 3/27/2024 12:00:00 AM

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Commercial Sales Manager
  • AutoZone, Inc.
  • Springfield, IL
  • The Commercial Sales Manager is responsible for driving the commercial sales within their AutoZone location. The CSM dev...
  • 3/26/2024 12:00:00 AM

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RN / LPN (Night Shift) - Springfield, IL
  • Gateway Foundation Inc
  • Springfield, IL
  • Pay Differential: Hours worked from 11:00 PM to 7:30 AM will be paid an additional $4.00 per hour. Are you looking to fi...
  • 3/26/2024 12:00:00 AM

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Nurse Practitioner
  • Milan Laser Company
  • Springfield, IL
  • About Milan Laser Hair Removal Milan Laser Hair Removal is one of the nation's premier laser hair removal providers. Tha...
  • 3/26/2024 12:00:00 AM

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Entry Level Class A CDL Truck Driver - HIRING IMMEDIATELY NO EXPERIENCE!
  • Western Express
  • SPRINGFIELD, IL
  • HAVE YOUR CDL-A? SPEAK WITH A SEATING SPECIALIST TODAY! (888) 383-3192 Why wait to earn more? Western Express has immedi...
  • 3/25/2024 12:00:00 AM

Springfield is the capital of the U.S. state of Illinois and the county seat of Sangamon County. The city's population of 116,250 as of the 2010 U.S. Census makes it the state's sixth most populous city. It is the largest city in central Illinois. As of 2013, the city's population was estimated to have increased to 117,006, with just over 211,700 residents living in the Springfield Metropolitan Statistical Area, which includes Sangamon County and the adjacent Menard County. Present-day Springfield was settled by European Americans in the late 1810s, around the time Illinois became a state. The...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Reimbursement Specialist - Healthcare jobs
$42,872 to $52,094
Springfield, Illinois area prices
were up 1.3% from a year ago

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You will also be notified when something of note is happening around the Coding and Reimbursement Specialist program.
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MedCert’s Reimbursement and EHR Specialist Certification program is well rounded and features 24/7 access to the curriculum with video and course content, program supplements, and all the resources your need for successful independent study.
January 08, 2020