Reimbursement Specialist

DESCRIPTION OF POSITION:

• Reimbursement specialists are responsible for evaluating and overturning denials to provide denial trend information to leadership. As an integral role of the Claims Escalation Team, the Reimbursement Specialist monitors outstanding payer issues and provides intensive follow up to ensure billing, coding, and collection process are followed to maximize reimbursement.

RESPONSIBILITIES AND DUTIES:

• Accurately identifies and evaluates denials and underpayments in order to determine reason and investigates the issue to determine the best course of action to have payer pay at the maximum reimbursement allowed per our contract.
• Understands payer contracts and how to analyze them in order to preview an account to determine if properly paid and identify when errors are made in payments.
• Utilizes system resources in order to compile reports and provide accurate feedback regarding Denials and Underpayments to Leadership.
• Communicates effectively with assigned payer, other departments and leadership to identify trends, help find solutions and implement changes that will positively affect reimbursement.
• Accurately evaluates each account in order to determine what is needed, what is left outstanding, and what steps are necessary to resolve the account quickly.
• Properly utilizes productivity tracking mechanisms.
• Works at or above the weekly set productivity standard and completes tasks in a timely manner.
• Appropriately prioritizes work queue in order to work highest priority first based on assigned subjects.
• Documents all information in the System following the Clear Concise Consistent method.
• Consistently monitors assignment to ensure that all steps necessary to assist the Team with achieving its goals have been taken.
• Writes clearly and informatively.
• Edits work for spelling and grammar.
• Varies writing style to meet needs.

The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

EDUCATION AND WORK EXPERIENCE

• High school graduate or GED certificate, required.
• Minimum of 2-year experience in Healthcare, preferably in the insurance industry
• Proficient in Microsoft Office suite
• Analytical and problem-solving skills
• Excellent communication and interpersonal skills
• Ability to work well in a team environment
• Adequate keyboarding skills (40 words per minute typing rate)
• Strong organizational and communication skills, including ability to discuss medical issues.
• Negotiation skills including assertiveness and being proactive.

PHYSICAL DEMANDS/WORK ENVIRONMENT

• Work requires a variety of physical activities, including moving about within and outside of all hospital properties for long periods of time. 
• Must be able to respond quickly and effectively to emergency and non-emergent situations.
•  May be required to assist in controlling disorderly conduct or combative patients.
• Must be able to exchange accurate information with patient, family, peers and medical personnel.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.