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)
JOB SUMMARY:
Under the direction of PFS Leadership, the Reimbursement Specialist I is responsible for billing and collections of outstanding account balances for commercial, government, and managed care payors as assigned. The Reimbursement Specialist I is required to identify and report payor issues to their leadership. It is a requirement for the Reimbursement Specialist I to read, interpret and apply complex payor contract language to expected reimbursement calculations and pursue all payments due to the organization. The Reimbursement Specialist I must perform account collection activities utilizing internet resources and professional telephone communication etiquette. The Reimbursement Specialist I is required to compose professional written correspondence with all internal and external entities. This position expects the Reimbursement Specialist I to demonstrate organization and time management skills to manage account collections.
MINIMUM QUALIFICATIONS:
HS Diploma, GED or Equivalent
2 Years of Experience
Proficient in Microsoft Excel, Word and Outlook programs
PREFERRED QUALIFICATIONS:
Associate's degree
3 Years of Experience
The expected hiring range for this position is $20.00 to $27.50
Rady Children’s Hospital is committed to compensation that is externally competitive and internally equitable. We demonstrate this commitment by conducting regular market reviews to remain competitive with organizations of similar size in the nonprofit, healthcare sector. The range listed above does not represent the full salary range for the position but is the expected hiring range for qualified candidates. Compensation decisions consider a variety of factors including experience, education, licensure, unique skillsets, organizational need, and internal equity. This posting will remain open from the “date posted” until the hiring manager has determined there is a sufficient applicant pool or until the position is filled.
Clear All
0 Reimbursement Specialist - Healthcare jobs found in San Diego, CA area