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)
Summary
Provides administrative, clerical and primarily, billing support to the agency.
Education and Formal Training: High school diploma or equivalent required; training in medical terminology preferred.
Work Experience: Experience in medical billing required; experience in Home Health Medicare billing preferred.
Knowledge, Skills and Abilities Required: Demonstrates a high level of mental and emotional tolerance and even temperament when dealing with people; uses tact, sensitivity, sound judgment, and a professional attitude when relating with patients, families, and co-workers at all times. Demonstrates knowledge of appropriate skills for communication with individuals of all ages, especially the geriatric population. Must develop thorough knowledge of current home care emergency policies and procedures, fire, safety and disaster policies.
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