Reimbursement Specialist
Specialty Billing Solutions - Lakewood, CO

This job posting is no longer available on Specialty Billing Solutions. Find similar jobs: Reimbursement Specialist jobs - Specialty Billing Solutions jobs

DESCRIPTION

Job Summary: The Reimbursement Specialist is responsible for thoroughly understanding the payor contracts for multiple facilities. The Reimbursement Specialist validates and tracks credits due to insurance companies and patients, assists with payment posting and performs essential Cash Receipts Manager duties in their absence.

Job Relationships: The Reimbursement Specialist reports directly to the Cash Receipts Manager and interacts with the VP of Revenue Cycle Management, facility Directors of Operations, accountants, and inter-office personnel in all areas pertaining to his/her position

DUTIES

1. Review refund requests on a daily basis for completeness by comparing documentation against specific facility contracts with various government, commercial and private payors.
2. Submit refund requests in good order to VP of Revenue Cycle Management for approval daily.
3. Compile and sends the necessary documentation to the accountants for refund check processing bi-monthly.
4. Inform facility Directors of Operations when refunds are submitted to accountants for processing
5. Track essential check posting information in the Credit Balance Spreadsheet for all facilities.
6. Update the Credit Balance Spreadsheet on a daily basis when checks clear the bank.
7. Compile refunds that have cleared the bank for posting by the Cash Receipts Analysts bi-monthly.
8. Ensure all refund checks cleared within the posting month are gathered and delivered to the Cash Receipts Analysts before the facility closes financials for the month.
9. Performs follow-up on checks that have not cleared the bank and researches checks that are returned for insufficient address.
10. Prepare Refund Request Forms and supporting documentation regarding overpayment calculations.
11. Assist Cash Receipts Manager with audits of adjustment and payment posting.
12. Identify and share payment/adjustment trends with Receipts Manager to assist in ongoing training of CBO personnel.
13. Daily/weekly/monthly balancing of all posting activity performed.
14. Posting within 24-48 hours - 48 hours would be the exception.
15. Track renewal dates on all contracts via contracts calendar.
16. Inform VP of Payor Contracting of upcoming renewal dates in advance.
17. Manage all incoming updated reimbursement summaries.
18. Assist in new procedure pricing projects - pull RVU values and current payor reimbursement and communicate findings.
19. Proactively communicates with Cash Receipts Manager.
20. Cross-train with Receipts Manager when asked and performs essential duties in his/her absence.
21. Observes CBO policies and procedures.
22. Actively observes CBO standards of conduct and participates in compliance program.
23. Attends CBO and departmental staff meetings.
24. Maintains HIPAA patient confidentiality standards for medical and financial information.
25. Performs all other duties as assigned.

QUALIFICATIONS

1. Education - High school diploma or equivalent required.
2. Work Experience - A minimum of one year payment posting experience required. Knowledge of medical terminology and computer literacy are required. Familiarity with payer contracts preferred.
3. Relationships - the ability to establish professional, open and honest relationships with owners, clients, management and co-workers, promoting a positive attitude and culture to all parties you encounter daily.
4. Skills - Basic office skills required; advanced office skills preferred. Strong working knowledge of Excel. Strong communication skills. Accurate data entry skills. Attention to detail a must. Ability to identify trends in underpayments/overpayments. High level of mathematical/analytical aptitude.
5. Physical Guidelines - Ability to extend wrists/arms for up to eight hours/day; sit for up to eight hours/day; and work at computer terminal for up to eight hours/day.
1. Review refund requests on a daily basis for completeness by comparing documentation against specific facility contracts with various government, commercial and private payors.
2. Submit refund requests in good order to VP of Revenue Cycle Management for approval daily.
3. Compile and sends the necessary documentation to the accountants for refund check processing bi-monthly.
4. Inform facility Directors of Operations when refunds are submitted to accountants for processing
5. Track essential check posting information in the Credit Balance Spreadsheet for all facilities.
6. Update the Credit Balance Spreadsheet on a daily basis when checks clear the bank.
7. Compile refunds that have cleared the bank for posting by the Cash Receipts Analysts bi-monthly.
8. Ensure all refund checks cleared within the posting month are gathered and delivered to the Cash Receipts Analysts before the facility closes financials for the month.
9. Performs follow-up on checks that have not cleared the bank and researches checks that are returned for insufficient address.
10. Prepare Refund Request Forms and supporting documentation regarding overpayment calculations.
11. Assist Cash Receipts Manager with audits of adjustment and payment posting.
12. Identify and share payment/adjustment trends with Receipts Manager to assist in ongoing training of CBO personnel.
13. Daily/weekly/monthly balancing of all posting activity performed.
14. Posting within 24-48 hours - 48 hours would be the exception.
15. Track renewal dates on all contracts via contracts calendar.
16. Inform VP of Payor Contracting of upcoming renewal dates in advance.
17. Manage all incoming updated reimbursement summaries.
18. Assist in new procedure pricing projects - pull RVU values and current payor reimbursement and communicate findings.
19. Proactively communicates with Cash Receipts Manager.
20. Cross-train with Receipts Manager when asked and performs essential duties in his/her absence.
21. Observes CBO policies and procedures.
22. Actively observes CBO standards of conduct and participates in compliance program.
23. Attends CBO and departmental staff meetings.
24. Maintains HIPAA patient confidentiality standards for medical and financial information.
25. Performs all other duties as assigned.

Specialty Billing Solutions - 17 months ago - save job