Reimbursement Specialist
Job Location:
Waterloo, WI - USA
Monthly Salary:
Posted:
Application Deadline:
Vacancies:
Job Summary
HOMELINK a business unit within VGM Groups family of businesses is an innovative national provider of integrated specialty services for the healthcare and workers compensation industries. HOMELINK provides a comprehensive offering of ancillary care products and services including advanced clinical programs and partners with both payers and providers. As a privately held employee-owned company HOMELINK team members are committed to delivering high quality service from referral to resolution. To learn more about VGM HOMELINK visit our website at .
Position Summary
The Reimbursement Specialist is a subject matter expert for workers compensation and CMS Medicare fee schedules and bill review. The Reimbursement Specialist is responsible for determining appropriateness of charges enforcing bill review edits and maintaining up-to-date knowledge of federal and state fee schedules rules and regulations.
All HOMELINK team members will be expected to follow strict confidentiality and HIPAA privacy and security guidelines.
Whats more At VGM Group we are 100% employee owned. Click to view more about VGM!
Reporting to:TBD
Working Location:On-site in Waterloo IA hybrid or remote opportunities available.Employees whose primary residence is around a 30-mile radius of VGM Main Campus are expected to work onsite at least four days per week. Specifics will be under the leaders discretion and subject to manager approval and business needs.
Work Hours Classification:Full-time Monday-Friday
Key Responsibilities
Duties Include:
- Analyze interpret and maintain relevant knowledge of federal state workers compensation commercial and third-party pricing
- Research all required sources of documentation for federal and state fee schedules including current data and fee schedule information
- Educate operations and technical teams and update documentation pertaining to regulatory changes
- Educate leadership sales and account management teams about major pricing changes to Medicare and workers compensation fee schedules.
- Ensure that billing practices adhere to payer regulations and industry standards
- Provide expertise on which bills to formally dispute with bill review companies.
- Assist with audit readiness and payer audits.
- Use CPT HCPCS and ICD-10 codes fee schedules and other resource materials to determine appropriate reimbursement of billed services including applicable fee schedule and/or repricing rationale
- Represent HOMELINK on external client-facing calls as a subject matter expert in the above areas
- Other duties as assigned
Key Qualifications
Education and experience:
- Minimum 5 years workers compensation and/or group health bill review experience
- Revenue Cycle Management Specialist and/or Certified Professional Coder certifications preferred
- Must comply with continuing education per Company regulatory contractual and accreditation requirements.
Skills and competencies:
- Knowledge of healthcare industry billing and/or coding terminologies such as ICD-10 HCPCS CPT and modifiers.
- Exemplary relationship management skills to communicate effectively with employees management and insurance companies
- Ability to routinely adapt to change while working in a fast paced complex environment
- Team player with excellent communication skills
- Strong time management and organization skills
- Strong analytical and problem-solving skills
Physical requirements:
- Operation of office equipment and using technology efficiently such as computers phones misc. office equipment
- Visual abilities to include reading distance vision and peripheral vision
- Moving throughout the VGM facilities when needed.
Learn more about VGM Group Inc.:
Headquartered in Waterloo Iowa VGM is a 100% employee-owned company providing business and professional services to thousands of business customers across North America. Services include group purchasing commercial insurance management of healthcare services and networks in post-acute cases healthcare distribution direct to patient homes specialty consulting online education digital print and traditional marketing and more. VGM employs approximately 1700 people across 40 states and Canada with more than 1100 working in Iowa. VGM has been named the Top Workplace in Iowa on multiple occasions and is proud of its role in the communities in which it serves. For more information visit ..
The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors including the scope complexity and location of the role; the skills education training credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program employees are also eligible for performance-based cash incentive awards.
This job description reflects the general duties of the job but is not a detailed description of all duties which may be inherent to the position. Reasonably related additional duties may be assigned to the individual Associate.
VGM Group Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race color religion age sex national origin disability status genetics protected veteran status sexual orientation gender identity or expression or any other characteristic protected by federal state or local laws.
This policy applies to all terms and conditions of employment including recruiting hiring placement promotion termination layoff recall transfer leaves of absence compensation and training.
Required Experience:
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