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)
Title: Healthcare Compliance Specialist - Practice Plan
Department Org: Internal Audit - 104920
Employee Classification: U1 - Unclassified PSA FT
Bargaining Unit: Professional Staff Association
Primary Location: MC AD
Shift: 1
Start Time: 8:30am End Time: 5pm
Posted Salary: $57,246- $71,526
Float: No
Rotate: No
On Call: No
Travel: No
Weekend/Holiday: No
Job Description:
The Healthcare Compliance Specialist – Practice Plan is responsible for assisting with overseeing and guiding the Compliance Program for the Physicians Practice Plan (UTP). Duties include ensuring ethical and compliant practices are implemented and maintained across the organization in accordance with all applicable federal and state laws, regulations, ordinances, commercial payers’ rules and regulations internal policies and procedures, and other requirements as they relate to operations, billing, coding, proper payment, documentation practices, and the delivery of quality care in a compliant manner. This person oversees doing investigations in the field, working with general counsel, managing hotline calls, and managing risk as it related to compliance issues.
Minimum Qualifications:
Conditions of Employment:
Equal Employment Opportunity Statement:
The University of Toledo is an equal opportunity, affirmative action employer. The University of Toledo does not discriminate in employment, educational programs, or activities on the basis of race, color, religion, sex, age, ancestry, national origin, sexual orientation, gender identity and expression, military or veteran status, disability, familial status, or political affiliation.
The University is dedicated to the goal of building a culturally diverse and pluralistic faculty and staff committed to teaching and working in a multicultural environment and strongly encourages applications from women, minorities, individuals with disabilities, dual-career professionals and covered veterans.
The University of Toledo provides reasonable accommodation to individuals with disabilities. If you require accommodation to complete this application, or for testing or interviewing, please contact the Human Resources Department at 419-530-4747 between the hours of 8:30AM and 5:00PM or apply online for an accommodation request.
Computer access is available at most public libraries and at the Office of Human Resources located in the Center for Administrative Support on the Main Campus of the University of Toledo.
Advertised: 07 Mar 2024 Eastern Standard Time
Applications close:
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