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)
Employee provides billing processing and follow-up related to reimbursement of funds for the majority of agency fees including all State Plan Option Medicaid, MR Waiver Medicaid, Medicaid Taxi, Medicare, and managed care contracts. Work involves performing Utilization Reviews to insure that proper documentation supports each billing, along with the coordination of Medicaid, Medicare, and all managed care billings, including the tracking of client usage so that stated limitations to treatment are not exceeded. Employee is responsible for researching problem accounts and taking appropriate action, and for providing direction to other staff relating to third party insurance follow-up. Employee is also responsible for maintaining files and records.
High School diploma supplemented by college-level course work in accounting, recordkeeping, insurance, or related field, and 1 to 2 years of experience in insurance collections and bookkeeping; or any equivalent combination of training and experience which provides the required skills, knowledge, experience, and abilities.
Must possess a valid Virginia driver's license.
MPNN CSB is an Equal Opportunity Employer and a Drug-Free Workplace committed to workforce diversity.
Position Open Until Filled.
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