Reimbursement Specialist - Healthcare jobs in Chattanooga, TN
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)
Recently Added Reimbursement Specialist - Healthcare jobs
Reimbursement Specialist - Infusions
- Candidate Experience site
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Rome, GA
FULL_TIME
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Job Summary: The Reimbursement Specialist (RS) has a primary area of expertise or experience within the reimbursement functions related oral chemotherapy agents. These functions include intake, revenue qualification, prescription-pharmacy coordination, and billing of such services. The Reimbursement Specialist is responsible for entry of information, verification of benefits, payer administrative protocols, the billing or prescriptions, and coordinating with outside pharmacies for service delivery.
Qualifications:
1. Education: High school diploma or equivalent required.
2. Experience: Previous hospital or medical experience preferably in a billing,
3. Collecting, or reimbursement position, with some clinical knowledge.
4. Ability to learn and understand pharmacy and medical benefit reimbursement issues, as well as Medicare, Medicaid, and other third party payer guidelines is required.
5. Possesses a basing understanding of medical terminology.
6. Possesses comfort and accuracy in working with computers, software such as
7. Microsoft office, and computer based pharmacy billing and electronic health records systems.
8. Ability to communicate and interface effectively with others.
9. Ability to work independently, as well as with others, to plan and organize work assignments.
10. Ability to maintain professional composure while handling stressful calls and situations.
Essential Job Functions:
11. Gathers a myriad of information from multiple sources and compiles it in a correct and comprehensive manner.
12. Processes prescriptions from medical providers.
13. Enters patient demographics, insurance information, as well as other relevant data in appropriate computer systems. Ensures information logged is accurate and entered in a timely manner.
14. Ensures all applicable staff receives communication in a timely fashion.
15. Performs comprehensive insurance verification and revenue qualification processes; authorization and re-authorization of benefits; and ensures that a source of payment, whether governmental, commercial insurance, or private pay, is available for all products and services provided.
16. Coordinates authorized products and services with clinical personnel to ensure a smooth reimbursement process and onboarding of patient to oral chemotherapy.
17. Knowledgeable of general pharmacy and medical benefit billing and reimbursement practices of commercial insurance carriers, Medicare and Medicaid. Researches and understands general billing guidelines and applies these standards appropriately.
18. Verifies the presence of necessary supplemental paperwork and/or information necessary for submitting a claim. Ensures we are compliant in our paperwork and billing practices as determined by state and federal guidelines.
19. Prepares the appropriate claim forms and transmissions in accordance with payer requirements.
20. Responsible for following-up on the status of pending prescriptions, as necessary.
21. Facilitates effective coordination of services by communicating with pharmacy, nursing, reimbursement, distribution and other staff.
22. Participates in patient/staff education and training programs as necessary.
23. Obtains referral numbers, prior authorizations, and pre-certs when necessary, and maintains log of this information.
24. Appropriately coordinates prescription information with nursing and pharmacy to ensure that documentation is in place to begin treatment.
25. Becomes proficient with the current EMR system(s) of use for communication, scheduling, and document retrieval.
26. Discusses financial information with patients regarding the prescriptions provided.
27. Works with pharmacy and other staff in obtaining any assistance funding, as necessary.
28. Communicates to all parties in a clear and understandable manner.
29. Is friendly and pleasant when dealing with others.
30. Demonstrates a thorough knowledge of all areas of responsibility and shares knowledge appropriately.
31. Exhibits effective problem solving techniques and looks for opportunities to contribute to the improvement of processes.
32. Maintains a positive and professional attitude in all situations.
33. Maintains strictest confidentiality.
34. Performs other duties as assigned. - 1 Month Ago
Healthcare Recruiter
- Maxim Healthcare Services
-
Chattanooga, TN
FULL_TIME
- Why Maxim Healthcare?When you work at Maxim, you’re part of a network of more than 175 local offices that have deep roots in each of the communities we serve, while still leveraging the resources and ...
- Just Posted
Billing Specialist | Skilled Nursing (remote)
- Ahava Healthcare
-
Chattanooga, TN
FULL_TIME
- Prema Financial Solutions has a great opportunity for a Billing Specialist! Prema Financial Solutions was created with the intention of providing excellence in timely financial, reimbursement and reve...
- 1 Month Ago
Permanent Clinical Education Specialist Registered Nurse
- Aya Healthcare
-
Rome, GA
FULL_TIME
- Aya Healthcare has an immediate opening for the following position: Clinical Education Specialist Registered Nurse in Rome, Georgia. This is a 104 week contract position that requires at least one yea...
- 1 Month Ago
Registered Nurse / Home Healthcare
- Cross Country Healthcare
-
Ringgold, GA
FULL_TIME
- Job DescriptionAs a home health nurse (RN HH), you will deliver healthcare in patients' residences, helping them maintain their independence. You will provide one-on-one care for patients in their hom...
- 5 Days Ago
Registered Nurse / Home Healthcare
- Cross Country Healthcare
-
Ringgold, GA
FULL_TIME
- Job DescriptionAs a home health nurse (RN HH), you will deliver healthcare in patients' residences, helping them maintain their independence. You will provide one-on-one care for patients in their hom...
- 5 Days Ago
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0 Reimbursement Specialist - Healthcare jobs found in Chattanooga, TN area
Data Entry Specialist (Work From Home)>
- CareMetx
-
Chattanooga, TN
- [Administrative Assistant / Fully Remote] - Anywhere in U.S. / Competitive Pay - As a Data Entry Specialist you'll: Main...
- 4/23/2024 12:00:00 AM
Data Entry Specialist (Work From Home)>
- CareMetx
-
Soddy Daisy, TN
- [Administrative Assistant / Fully Remote] - Anywhere in U.S. / Competitive Pay - As a Data Entry Specialist you'll: Main...
- 4/23/2024 12:00:00 AM
Data Entry Specialist (Work From Home)>
- CareMetx
-
Ooltewah, TN
- [Administrative Assistant / Fully Remote] - Anywhere in U.S. / Competitive Pay - As a Data Entry Specialist you'll: Main...
- 4/23/2024 12:00:00 AM
Data Entry Specialist (Work From Home)>
- CareMetx
-
Ringgold, GA
- [Administrative Assistant / Fully Remote] - Anywhere in U.S. / Competitive Pay - As a Data Entry Specialist you'll: Main...
- 4/23/2024 12:00:00 AM
Data Entry Specialist (Work From Home)>
- CareMetx
-
Cleveland, TN
- [Administrative Assistant / Fully Remote] - Anywhere in U.S. / Competitive Pay - As a Data Entry Specialist you'll: Main...
- 4/23/2024 12:00:00 AM
Data Entry Specialist (Work From Home)>
- CareMetx
-
Dalton, GA
- [Administrative Assistant / Fully Remote] - Anywhere in U.S. / Competitive Pay - As a Data Entry Specialist you'll: Main...
- 4/23/2024 12:00:00 AM
Data Entry Specialist (Work From Home)>
- CareMetx
-
Chatsworth, GA
- [Administrative Assistant / Fully Remote] - Anywhere in U.S. / Competitive Pay - As a Data Entry Specialist you'll: Main...
- 4/23/2024 12:00:00 AM
Electrical Lead - Power System Studies/Water/Wastewater - Phoenix, AZ US- Hybrid
- Black & Veatch
-
Chattanooga, TN
- **Electrical Lead - Power System Studies/Water/Wastewater - Phoenix, AZ US- Hybrid** Date: Apr 19, 2024 Location: US Pho...
- 4/23/2024 12:00:00 AM
About Chattanooga, Tennessee
According to the United States Census Bureau, the city has a total area of 144.6 square miles (374.4 km2), of which 137.1 square miles (355.2 km2) are land and 7.4 square miles (19.2 km2), or 5.12%, are water. The most prominent natural features in and around Chattanooga are the Tennessee River and the surrounding mountains. The city is nestled between the southwestern Ridge-and-valley Appalachians and the foot of Walden's Ridge; the river separates the ridge from the western side of downtown. Several miles east, the city is bisected by Missionary Ridge.
The Tennessee River is impounded by th...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Reimbursement Specialist - Healthcare jobs
$40,948 to $49,757
Chattanooga, Tennessee area prices
were up 1.3% from a year ago
were up 1.3% from a year ago
What does a Reimbursement Specialist - Healthcare do?
Reimbursement Specialist - Healthcare in Anchorage, AK
Bureau of Labor Statistics, occupations and industries related to healthcare are projected to add more new jobs to the U.S.
December 07, 2019
Reimbursement Specialist - Healthcare in Brownsville, TX
You will also be notified when something of note is happening around the Coding and Reimbursement Specialist program.
January 26, 2020
Reimbursement Specialist - Healthcare in Charlotte, NC
MedCert’s Reimbursement and EHR Specialist Certification program is well rounded and features 24/7 access to the curriculum with video and course content, program supplements, and all the resources your need for successful independent study.
January 08, 2020