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: 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 timely applying all insurance payments and adjustments to charges. The Cash Posting Specialist works closely with registration, billing, financial navigators and collection agency.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
OTHER DUTIES:
EDUCATION/QUALIFICATIONS: High school graduate or equivalent. Previous experience in medical office registration, billing and or collections. Excellent attention to detail, problem solving and critical thinking. Working knowledge of Microsoft Word and Excel. Must take EPIC training and successfully pass required tests.
KNOWLEDGE/SKILLS/ABILITIES: General knowledge of basic manual and computerized accounting and billing systems. Excellent Math, Verbal and written English communication skills. Eye, hand, and auditory coordination. Basic computer skills. Problem solving and prioritization skills. Ability to work independently with minimal supervision and as part of a team; ability to work under pressure with time constraints; ability to meet deadlines and work with frequent interruptions; ability to concentrate, provide close attention to detail, and handle multiple tasks simultaneously. Ability to adapt to an individual’s learning needs and requirements; ability to grasp billing system concepts and clearly explain their application; ability to demonstrate patience and support throughout learning experiences; ability to research and clarify system issues. Ability to maintain professional attitude at all times; ability to handle telephone and face-to-face contact with patients, physicians and other staff. Ability to function in a sometimes demanding and fast-paced work environment related to changing patient needs, including work with patients with acute, chronic, and complex disease processes and those who are dying. Understands and practices patient confidentiality. A positive attitude towards health care team members and diverse patient populations.
PHYSICAL REQUIREMENTS OF JOB: Standing, walking, sitting, carrying, pushing, pulling, lifting, bending, stooping, squatting, crouching, twisting, reaching, handling, kneeling, and wrist and digital dexterity. Involves significant degree of data entry. Involves significant degree of sitting, and involves standing or walking for brief periods of time. Speaking, hearing, and visual acuity to communicate with patients, physicians and other health care professionals; use telephone system; and operate office equipment and computers. Exerting force (frequently up to 10 pounds and occasionally up to 20 pounds or more) to lift, carry, push, pull or otherwise move objects, including office supplies, medical charts, billing forms, etc. Limited driving.
MENTAL DEMANDS: Must be able to work under stress and adapt to changing conditions. Must be able to concentrate and focus on details. Must be able to prioritize requirements of the Reimbursement Specialist functions with additional training responsibilities.
WORKING CONDITIONS: Normal medical office environment. Job duties involve minimal potential for exposure to blood and body fluids, chemical disinfectants, and limited exposure to chemicals such as cleaning disinfectants and toners for office equipment.