Senior Reimbursement Specialist
Senior Reimbursement Specialist
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Job Description
We are searching for a Sr. Reimbursement Specialist someone who works well in a fast-paced managed care this position you will design develop and manage the denial and underpayment databases for Patient Accounting. This role will primarily be responsible for monitoring and tracking managed care reimbursement and denials to provide weekly monthly and yearly reports to management of trends.
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Job Duties & Responsibilities
Creates and maintains denial and underpayment databases to ensure that all denied and underpaid accounts are identified and trended to improve collections and reduce denials
Assists Patient Account Managers with training in resolving reimbursement issues related to managed care and other discounted accounts
Meets with payers to maintain productive relationships with the insurance companies managed care organizations and government agencies to resolve reimbursement and slow payment problems
Provides weekly monthly and annual reports for Business Service Leadership and VP of Finance to manage and monitor Accounts Receivable and Revenue Cycle
Provides period audits on accounts by payer to ensure that accounts are reimbursed appropriately and contractual discounts are recorded accurately
Develops reimbursement reports for the Health Centers and Learning Support centers
Works closely with Decision Support team to ensure that reimbursement and collections data is accurate
Develops and maintains positive relationships with physicians providers and practice managers throughout the delivery system
Actively participates in the development and implementation of the action plans for the department in response to Business Services adoption of Continuous Quality Improvement
Skills & Requirements
High School Diploma or GED
7 years of experience in accounting contracting collections provider relations or patient access area
A Bachelors degree may substitute for 4 years of the required experience
Knowledge of State Federal and third-party claims processing and the laws of the State Insurance Board and Fair Collection Act
Understand all types of managed care payment plans such as HMOs PPOs POS and EPO plans
Required Experience:
Senior IC
Employment Type
Full-Time
