Reimbursement Specialist

Job Function and Responsibilities

The Reimbursement Specialist performs the daily functions of account resolution which primarily includes researching accounts, analyzing EOBs/remittances, and interacting with insurance companies for resolution of denied/underpaid balances. Must be a hands-on problem solver and effective communicator to support the goals of Burke Hospital System. We are seeking an individual with experience in appeals, denials, has an understanding of managed care contracts, Medicare/Medicaid, knowledge of medical procedures, and terminology.

Job Duties/Performance Expectations

• Audit claims to identify and track denials and other issues that contribute to the slow time to reimbursement
• Follows up with appropriate departments and teams to reduce denial rates and preventable write offs.
• Reviews records for medical necessity, accurate patient class, physician orders, authorizations, level of care, etc., to determine course of action to overturn insurance carrier denial and/or resolve customer service inquiries.
• Prepare appeal letters and documentation packets to facilitate overturning denial decisions.
• Communicate professionally with multiple internal and external departments on researching and compiling questionable insurance denials practice for escalation to payer representatives.
• Provide any needed documentation to justify appeals including but not limited to letters of medical necessity, case briefs outlining disposition reversal, CMS guidelines, peer reviewed journal references, etc.
• Monitors problem accounts from scheduling to payment to ensure clean claim submission and timely resolution.
• Maintain compliance with all applicable rules and regulations.
• Performs other related duties as assigned.

QUALIFICATIONS/EXPERIENCE

Required:

• Minimum of 2 years revenue cycle experience in a healthcare setting
• Knowledge of UB04 and 1500 billing and coding requirements related to Orthopedics and Cardiology
• Demonstrate strong written, oral and positive communication and facilitation skills.
• Proficiency in Microsoft Office, especially Excel. Strong computer skills with the ability to learn multiple applications.

Preferred:

• Knowledge of APC's, APG's and DRG's reimbursement mandates.
• Knowledge of third-party rules and regulations and charge methodology.
• Requires knowledge of medical terminology; payor reimbursement guidelines (authorization / notification, medical necessity, and timely filing guidelines); payor denial appeal resolution processes; and managed care contracts.

DFWP/EOE

Job Type: Full-time

Pay: $25.00 per hour

Expected hours: 40 per week

Benefits:

• Dental insurance
• Employee assistance program
• Employee discount
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Work setting:

• Clinic
• Hospital
• Hybrid work

Experience:

• Hospital Reimbursement: 3 years (Required)
• ICD-10: 2 years (Required)

Work Location: Hybrid remote in Waynesboro, GA 30830