Reimbursement Specialist

UP Health System - Marquette

Who We Are:
People are our passion and purpose. Come work where you are appreciated for who you are not just what you can do. UPHS Marquette is a 222 bed hospital and houses the regions only Level II Trauma Center and Neonatal Intensive Care Unit (NICU). We also provide outreach with programs like annual health and safety fairs health screenings for the entire family and more to keep our community healthy!

Where We Are:
In Marquette our fascinating history rural landscape abundant recreational opportunities and welcoming people make the Upper Peninsula someplace special. From a thriving culinary scene to charming shops to historic lighthouses and museums there is something for everyone in this beautiful lakeside gem.

Why Choose Us:
Health (Medical Dental Vision) and 401K Benefits for full-time employees
Competitive Paid Time Off / Extended Illness Bank package for full-time employees
Employee Assistance Program mental physical and financial wellness assistance
Tuition Reimbursement/Assistance for qualified applicants
Opportunities for education and training through partnership with Duke LifePoint Healthcare
And much more

Position Summary:

Reconciles and posts all payments received identifies discrepancies and analyzes issues to ensure payments are posted timely.

Reports to: Director Revenue Cycle

FLSA: Non-exempt

ESSENTIAL FUNCTIONS:

Maintains established hospital and departmental policies and procedures objectives performance improvement program safety environment of care management of information and infection control standards.

Review and validate adjustments to accounts based on insurance reimbursement coverage contracts and services provided.

Analyze and reconcile denied payment transactions.

Audits payments from 3rd party payers for compliance with contracted amounts.

Assists with the preparation and maintenance of department reports. Prepares periodic reports for senior management as delegated by the director.

Works closely with clinical staff physicians other department stakeholders patient accounting and scheduling areas.

Reviews charges for correct coding completeness and accuracy of demographic and insurance data.

Prepares specific financial reports as assigned.

Reviews claim pertaining to billing authorization coding and documentation requirements. When necessary implements action plans to prevent denials and rejection recurrence with Directors approval.

Coordinates various R1 processes to ensure expeditious billing performance.

Demonstrates effective problem-solving an ability to communicate verbally and in writing and a willingness to adapt to changing environment.

Maintains working knowledge of the flow of information that supports the billing process including medical documentation CPT HCPCS ICD MSDRG and other applicable documentation required for compliant billing.

Assists in investigation documentation and resolution of various input and output computer application problems as identified and reported by audit reports computer vendors Information Technology or support personnel as necessary.

Promotes and maintains positive working relationships within the department and with other areas throughout UPHS-M the community and outside agencies.

Demonstrates professionalism with fellow employees providers and patients in person on the telephone and in writing.

Demonstrates by his/her own behavior a strong sense of commitment to patient care.

Demonstrates respect for individual dignity and diversity.

Coordinates with other departments within the organization in a collaborative environment to ensure appropriate billing procedures are in compliance with third party payers federal/state law and accrediting/licensing agencies.

Maintains and fosters effective public relations with patients staff partners and the public.

Other Skills
Knowledge of office machines
Keyboarding
Supervisory
Excellent communication

JOB REQUIREMENTS:

Minimum Education
High school diploma
Current Coding Certification or obtained within 1 year of hire.
College degree in Business/Finance preferred

Required Skills
Requires critical thinking skills decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.

Required Skills
Licenses:

Minimum Work Experience
3-5 years in medical billing
Knowledge of business functions
Familiar with collection procedures
3-5 years supervisory experience preferred

EEOC Statement:
UP Health System Marquette is committed to providing Equal Employment Opportunities for all applicants and employees and complies with all applicable laws prohibiting discrimination against any employee or applicant for employment because of color race sex age religion national origin disability genetic information gender identity sexual orientation veterans status or any other basis protected by applicable federal state or local law.

Equal opportunity and affirmative action employers and are looking for diversity in candidates for employment: Minority/Female/Disabled/Protected Veteran