Reimbursement Specialist

Overview of Position The Reimbursement Specialist will follow up and pursuit of unpaid hospital insurance accounts. Possess proficiency in all aspects of facility hospital claims, insurance collections follow up including billing, coding, contracts and reimbursement to pursue underpaid variances and denials. Subsequent verbal resolution push and/or submission of written payer disputes/appeals of underpaid accounts and denials, as well as corrected claim submission. Provide complete and thorough account reviews and audit documentation, as well as perform appropriate action steps to pursue payments for account resolution. What will be my duties and responsibilities in this job? + Excellent knowledge of insurance industry process and procedures+ Strong decision making, and problem-solving skills are needed, as well as an ability to work independently with minimal supervision.+ Understanding and knowledge of CPT-4/HCPC/DRG/ICD/HCPCs, and Revenue codes+ Enhanced knowledge of HIPAA privacy guidelines as well as maintaining and protecting all confidential information.+ Ability to multitask and set priorities on multiple projects for the highest rate of returns.+ Knowledge of Commercial, Medicare/Medicaid and Medicare/Medicaid HMO’s+ Understanding of A/R projects procedures and process, and the follow up required to drive collections+ Sorting and filtering in Excel skills requiredWhat are the requirements needed for this position?+ High school diploma or GED required + Prior experience in hospital revenue cycle billing, follow-up and reimbursement. + Requires at least 2 years prior experience in the healthcare field, specific to understanding the drivers causing hospital claim non-payment and denials, and the follow up dispute resolution processes required by the various insurance carriers/payers to overturn and generate reimbursement. What other skills/experience would be helpful to have?+ Possess and apply a thorough knowledge of pursuit of insurance hospital payments.+ Note and document accounts appropriately+ Request or bill corrected claims as needed+ Review hospital/provider notes, payments, refunds, recoups, and articulate underpayment causes and denials with payers+ Review variances and take appropriate action to engage the payers to render payment+ Request and review additional hospital information as appropriate+ Learn, comprehend and navigate complex hospital systems+ Follow HIPAA guidelines in handling patient information+ Prioritize workloads using tools and resources in the most efficient manner to produce highest levels of quality productivity leading to appropriate account resolution.What are the working conditions and physical requirements of this job? General office duties and conditions Must have acute hospital experience with Medicare. Must be proficient with FISS, DDE system and knowledge of Medicare billing and compliance guidelines Join our team today where we are creating a better coordinated, increasingly collaborative, and more efficient healthcare system! COVID Vaccination Requirements We remain committed to doing our part to ensure the health, safety, and well-being of our team members and our communities. As such, we require all employees to disclose COVID-19 vaccination status prior to beginning employment and we may require periodic testing for certain roles. In addition, some roles require full COVID-19 vaccination as an essential job function. Change Healthcare adheres to COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Equal Opportunity/Affirmative Action Statement Change Healthcare is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, genetic information, national origin, disability, or veteran status. To read more about employment discrimination protections under federal law, read EEO is the Law at https://www.Eeoc.Gov/employers/eeo-law-poster and the supplemental information at https://www.Dol.Gov/ofccp/regs/compliance/posters/pdf/OFCCP _EEO_Supplement_Final_JRF_QA _508c.Pdf.If you need a reasonable accommodation to assist with your application for employment, please contact us by sending an email to with ” Applicant requesting reasonable accommodation” as the subject. Resumesor CVs submitted to this email box will not be accepted.Click here https://www.Dol.Gov/ofccp/pdf/pay-transp _%20English_formattedESQA508c.Pdf to view our pay transparency nondiscrimination policy. 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